Postoperative changes of early-phase inflammatory indices after uncomplicated anterior cervical discectomy and fusion using allograft and demineralised bone matrix

Abstract

Purposes We investigated sequential levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in uncomplicated ACDF (anterior cervical discectomy and fusion) using allograft and DBM (demineralised bone matrix) for primary cervical spondylosis and/or disc herniation. To our knowledge, there has been no study to investigate the diagnostic value of CRP and ESR for postoperative infection in ACDF using allograft and DBM. Methods Blood samples of 85 patients, who underwent one-(n 051) or two-level (n 034) ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, 14th, 30th, and 90th postoperative days. No infection was found in any patient for at least one year follow-up period. Results Mean CRP value increased significantly on the first postoperative day and reached a peak on the third postoperative day. The peak level rapidly decreased but remained elevated on the fifth, seventh, and 14th postoperative days. Mean ESR value increased significantly and reached a peak on the third postoperative day. The peak level gradually decreased but remained elevated on the fifth and seventh postoperative days. One-and two-level ACDF exhibited similar postoperative changes in CRP and ESR values and no significant difference in mean levels of CRP and ESR throughout the follow-up periods. Conclusions This study demonstrates that uncomplicated ACDF using allograft and DBM showed significant abnormal values of CRP and ESR during the early postoperative period. This result suggests that abnormal values of CRP and ESR in the early postoperative period do not indicate acute postoperative infection after ACDF using allograft and DBM. Straying from the normal course, such as a second rise or a failure to decrease, of CRP and ESR is more important to signpost acute postoperative infection in ACDF using allograft and DBM.

Revision Surgery for Failed Cervical Spine Reconstruction

“…Concerns for infection at any time point after surgery should prompt evaluation with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete white blood cell count (WBC) with differential. In the normal postoperative period, CRP and ESR will peak on the third and fourth day, respectively, then CRP will decrease rapidly, and ESR will gradually decrease [24]. Both can still be elevated at 14 days after surgery, and ESR can remain elevated for up to 6 weeks [24].…”

“…In the normal postoperative period, CRP and ESR will peak on the third and fourth day, respectively, then CRP will decrease rapidly, and ESR will gradually decrease [24]. Both can still be elevated at 14 days after surgery, and ESR can remain elevated for up to 6 weeks [24].…”

“…In the normal postoperative period, CRP and ESR will peak on the third and fourth day, respectively, then CRP will decrease rapidly, and ESR will gradually decrease [24]. Both can still be elevated at 14 days after surgery, and ESR can remain elevated for up to 6 weeks [24]. A second rise in CRP, or a failure of CRP to decrease is concerning for infection [31] When treating an infection after surgery, the CRP level is more indicative of response to antibiotic treatment, as ESR may continue to be elevated [23].…”

Dilemmas surrounding the diagnosis of deep brain stimulation electrode infection without associated wound complications: A series of two cases

“…However, these indices frequently elevate postoperatively; based on literature regarding orthopedic procedures including spine surgery, these values may take 14 days to 90 days to normalize to preoperative levels. [ 1 9 11 ] Unfortunately, no significant data exist for cranial procedures. Consequently, a single high value after surgery may not indicate infection.…”