Postoperative Kinetics of C-Reactive Protein and Erythrocyte Sediment Rate in One-, Two-, and Multilevel Posterior Spinal Decompressions and Instrumentations

Abstract

Study design:Prospective study.Objective:To characterize the normal pattern of kinetics of postoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after decompression, spinal instrumentation, and posterolateral fusion in 1, 2, and more than 2 levels.Methods:Blood specimens were obtained from patients who underwent posterior decompression, instrumentation with pedicular screws, and posterolateral fusion from June 2009 to January 2011. CRP and ESR levels were measured on the day before surgery and on postoperative days 1, 3, 7, 11, 14, 28, and 42.Results:Mean CRP levels peaked on the third day postoperatively in all groups. By day 7 postoperatively, it had dropped rapidly. At the 14th and 28th postoperative days, decreases to normal CRP levels were found in 16% and 80% of all patients, respectively. The pattern of decline in CRP was similar among groups. Values of ESR increased and peaked between the third and seventh postoperative days. ESR values gradually decreased. At the 42 day postoperatively, ESR level still remain above normal values in all groups.Conclusions:We compared conventional operation groups of 1-, 2-, and more than 2-level posterior instrumentation and found no statistically significant differences in the peak of CRP level, the ESR value, and the pattern of decline. CRP levels of 80% of the patients returned to normal within 4 weeks.

Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

“…Maximum values of LC are seen on day one to three postoperatively and decline to normal values between day four to six 26 . Values of ESR peak at day seven to eleven postoperatively and decrease gradually until after week six 19 . Therefore, patients were excluded who underwent surgery in 14 days preceding testing for CRP, 7 days for LC and 6 weeks for ESR testing.…”

“…However, the added value of serum inflammatory markers is still under debate. Large cohort studies which tell us whether these markers are capable of distinguishing a bacterial infection from a normal inflammatory response due to the injury, tissue damage, fracture healing, or the fracture surgery, are lacking so far 15 - 19 . It is therefore mandatory to assess the role of these serum inflammatory markers in the decision-making process for diagnosing FRI.…”

Postoperative Spine Infection: Diagnosis and Management

“…11 If the CRP is elevated after this period, and even more specifically, if there is a second “bump” (ie, first elevation due to the normal inflammatory response to surgery, then a second elevation some number of days or weeks later), there is a high correlation with the presence of infection, with a sensitivity of 82%. 12 Combined trending of ESR and CRP values can be the most predictive method for diagnosing and monitoring treatment response of postoperative spinal infections; however, no laboratory method has demonstrated excellent specificity/positive predictive value.…”

Spinal Surgery and Subsequent ESR and WBC Changes Pattern: A Single Center Prospective Study

“…However, in patients without evidence of infection, postoperative ESR can increase due to muscle damage and blood transfusions. 3 15) Therefore, it is important to differentiate usual and normal postoperative ESR changes from pathologic ESR rise during a postoperative infection. Usually, 4 days after spinal fusion surgery and discectomy, the ESR can increase up to 102 mm/h and up to 75 mm/h, respectively, which gradually reduces from 2 to 4 weeks.…”