Published online Nov 19, 2026. doi: 10.5498/wjp.123546
Revised: July 15, 2026
Accepted: August 18, 2026
Published online: November 19, 2026
Processing time: 132 Days and 22.1 Hours
Transforaminal endoscopic lumbar discectomy (TELD) has increased significantly in recent years because of perceived advantages over traditional open lumbar discectomy as an effective and less invasive surgical technique. Although pain is effectively managed in most patients with TELD, postoperative anxiety has emerged as a substantial concern. Developing reliable predictors of postoperative anxiety in patients undergoing TELD is urgently needed. The predictive ability of the systemic immune-inflammation index (SII), a subclinical inflammatory mar
To investigate the association between SII, selected inflammatory and immune-related markers, and postoperative anxiety in patients undergoing TELD.
This retrospective study included 180 patients who underwent TELD from 2022 to 2023. Participants were divided into anxiety and non-anxiety groups based on the Hospital Anxiety and Depression Scale-Anxiety assessment score, performed two weeks after surgery. SII value and levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, C reactive protein (CRP), procalcitonin (PCT), rheumatoid factor (RF), antinuclear antibodies, and immunoglobulin G, A, and M, were measured pre- and postoperatively. Multivariate logistic regression was performed to identify independent predictors of postoperative anxiety.
Of the 180 patients included in this study, 47 (26.1%) exhibited postoperative anxiety. Patients in the anxiety group had higher levels of SII, TNF-α, IL-6, CRP, and PCT than those in the non-anxiety group. Pre-operative RF levels were significantly higher in patients with postoperative anxiety (P = 0.032). Multivariate logistic regression analysis revealed that elevated levels of postoperative SII [odds ratio (OR) = 1.003, 95% confidence interval (CI): 1.001-1.005, P = 0.008], IL-6 (OR = 1.087, 95%CI: 1.021-1.158, P = 0.009), and CRP (OR = 1.045, 95%CI: 1.012-1.079, P = 0.007) were associated with higher odds of experiencing postoperative anxiety.
This study showed that higher levels of SII, IL-6, and CRP in patients who had undergone TELD can identify those at increased risk of developing postoperative anxiety.
Core Tip: This study found that increased levels of the systemic immune-inflammation index, interleukin-6, and C reactive protein following surgery are potential independent markers associated with the development of anxiety following a surgical procedure in patients undergoing transforaminal endoscopic lumbar discectomy. Assessing these combined inflammatory markers can serve as a risk stratification methodology to identify target patients who may develop anxiety following surgery. The results of this study support the growing focus on inflammation as a potential influence on the psychological aspect of recovery from spinal surgery.