Does pre-operative neutrophil–lymphocyte ratio predict patient-reported pain and functional outcomes at 12 months after anterior cervical discectomy and fusion?

Abstract

INTRODUCTION: Preoperative neutrophil-lymphocyte ratio (NLR) has been found in various fields to be a predictor of post-operative pain and functional outcomes. To date no studies have looked at NLR in relation to patient outcomes after anterior cervical discectomy and fusion (ACDF). The primary aim is to determine the relationship between pre-operative NLR, pain and functional outcomes at 12-months post elective ACDF. MATERIALS AND METHODS: This single-centre retrospective cohort study included 60 patients undergoing 1 or 2 level ACDF. Pre-operative NLR and demographic data were collected. Visual analogue scale (VAS) for neck and arm pain, and Neck Disability Index (NDI) were collected at baseline and 12 months postoperatively. Binary logistic regression was used to estimate the associations of demographic factors and NLR with improvement in VAS and NDI scores. RESULTS: A unit increase in NLR was associated with a 56% decrease in the odds of improvement in neck pain (OR: 0.44; CI: 0.21-0.89, p = 0.02). NLR was not found to be a statistically significant predictor of improvement in VAS Arm or NDI. Higher baseline VAS arm and neck scores were associated with greater odds of improvement in pain postoperatively. Compared to patients with cervical disc herniation, those with cervical stenosis had a 72% decrease in the odds of substantial clinical benefit in NDI score (OR: 0.28 CI: 0.09-0.91, p = 0.03). CONCLUSION: Elevated preoperative NLR was associated with lower odds of neck pain improvement after ACDF but did not predict disability or arm pain improvement.