Systemic Neuroinflammatory Signatures in Lumbar Spinal Stenosis: An Exploratory Correlation of Serum IL-1β and hs-CRP with Schizas Morphological Grading

Arazy Gifta Prima (Department of Orthopedics and Traumatology, Universitas Sriwijaya, Palembang, Indonesia)
Rendra Leonas (Department of Orthopedics and Traumatology, Universitas Sriwijaya, Palembang, Indonesia)
Theodorus (Medical Study Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia)

Sriwijaya Journal of Surgery
Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery

Introduction: The clinical-radiological paradox in lumbar spinal stenosis (LSS) suggests that anatomical compression alone fails to explain symptom severity. Emerging evidence points to a bio-active stenotic environment driven by chronic neuroinflammation. This study aimed to investigate whether the morphological severity of stenosis, graded by the Schizas classification, correlates with systemic inflammatory biomarkers (Interleukin-1β and high-sensitivity C-reactive protein) after strictly controlling for pharmacological confounders. Methods: A prospective, cross-sectional exploratory pilot study was conducted on 30 patients with degenerative LSS. To isolate stenosis-induced inflammation, strictly non-obese patients (BMI <30 kg/m²) underwent a verified 7-day NSAID/steroid washout period. Stenosis severity was graded on MRI using the Schizas classification. Due to small sample size in extreme stenosis, Grades C and D were merged into a severe stenosis cohort. Serum IL-1β and hs-CRP were quantified via ELISA. Statistical analysis utilized Kruskal-Wallis tests and bootstrapped multivariate linear regression (1,000 resamples) to control for Age, BMI, and multicollinearity (VIF). Results: The cohort was stratified into Grade A (n=10), Grade B (n=11), and Severe Grade C/D (n=9). Systemic inflammatory markers demonstrated a significant stepwise elevation corresponding to morphological severity. Median IL-1β levels rose from 5.60 (IQR 4.9–6.4) pg/mL in Grade A to 11.20 (IQR 9.1–13.8) pg/mL in the Severe group (p<0.001). Similarly, hs-CRP increased from 2.15 mg/L to 4.90 mg/L (p=0.003). Bootstrapped regression confirmed that Schizas severity remained a significant independent predictor of IL-1β (β=0.46, p=0.012) and CRP (β=0.49, p=0.009) with acceptable variance inflation factors (VIF < 2.5), validating the model despite age-related correlations. Conclusion: Morphological severity of the dural sac significantly correlates with systemic inflammatory burden. Severe mechanical compression appears to induce a spillover effect, creating a detectable peripheral inflammatory signature. These biomarkers may serve as objective adjuncts to MRI in conflicting clinical scenarios.