• Masahiko Sumitani, Atsushi Kimura, Takao Mochizuki, Toru Akiyama, Baasanjav Uranbileg, Takuya Takahashi, Takashi Hirai, Kentaro Hayakawa, Hirotaka Chikuda, and Makoto Kurano.
• Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: SUMITANIM-ANE@h.u-tokyo.ac.jp.
• World Neurosurg. 2024 Mar 1; 183: e571e575e571-e575.

BackgroundReoperation, sometimes multiple, is common with progressively worse outcomes in patients with degenerative lumbar spine diseases. Lysophosphatidylcholine (LPC), a precursor of lysophosphatidic acid, in the cerebrospinal fluid (CSF) is a possible biomarker for neuropathic pain and discriminating neuropathic pain caused by lumbar spinal canal stenosis (LSCS) from other etiologies. This study aimed to explore this possible use of LPC species in the CSF.MethodsPatients with LSCS (n = 137) and persistent spinal pain syndrome (n = 22) were subjected in this multi-site observational study. The CSF was collected by lumbar puncture. Using liquid chromatography-tandem mass spectrometry, we measured 6 LPC species, (16:0), (18:0), (18:1), (18:2), (20:4), and (22:6), in the CSF. We compared the LPC values between the groups and determined the cutoff levels that could efficiently discriminate the groups with high accuracy.ResultsThe levels of all measured LPC species were significantly higher in the LSCS group than the persistent spinal pain syndrome group. Four LPC species demonstrated more than 0.80 area under the curve obtained from the receiver operating characteristic curve analysis. Although the specificity of cutoff levels for the 6 LPC species was low to moderate, their sensitivity was consistently high.ConclusionsThe existing diagnostic protocols combining physical examinations and morphological imaging studies for lumbar spinal pain have limited sensitivity. Measuring LPC species in the CSF is a promising objective laboratory test and could be suitable for detecting the presence of lumbar spinal stenosis and can help indications for surgery.Copyright © 2024 Elsevier Inc. All rights reserved.

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