Associations of inflammatory biomarkers with clinical outcomes in degenerative lumbar spinal stenosis: A systematic review.

INTRODUCTION

Inflammatory pathways have been implicated in degenerative lumbar spinal stenosis (LSS), but the clinical relevance of inflammatory biomarkers is unclear.

RESEARCH QUESTION: What associations exist between inflammatory biomarkers and patient-centered outcomes in degenerative LSS, and secondarily with imaging features?

MATERIAL AND

METHODS

We conducted a PRISMA 2020-compliant systematic review. MEDLINE/PubMed, Embase, Cochrane Library, Scopus, Web of Science, CINAHL, and Academic Search Premier were searched from inception to July 4, 2025. We included original adult human studies of degenerative LSS reporting inflammatory biomarkers (tissue, serum/plasma, or cerebrospinal fluid [CSF]) with clinical and/or imaging outcomes. Risk of bias was assessed using a modified Newcastle-Ottawa Scale.

RESULTS

Of 1157 records identified (645 from databases; 512 from citation tracking), 14 studies met inclusion criteria. Biomarker-clinical outcome evidence was sparse and based on single studies: higher CSF NOx was associated with a lower postoperative recovery rate; higher serum MCP-1 with greater short-term satisfaction after epidural steroid injection; and higher serum miR-486-5p with more pain/disability and worse postoperative JOA scores. Most studies linked biomarkers to imaging severity, particularly ligamentum flavum hypertrophy and reduced dural sac cross-sectional area. Only one small study assessed both clinical and imaging outcomes: higher CSF IL-6 associated with smaller dural sac area but not pain intensity or walking distance.

DISCUSSION AND

CONCLUSION

Evidence connecting inflammatory biomarkers to patient-centered outcomes in degenerative LSS is limited. Reported associations are hypothesis-generating and require confirmation in standardized, adequately powered prospective studies before clinical application.