Defining the Normal Trends of Serum Creatine Kinase Levels Following Spinal Surgery

Abstract

Study Design Prospective, prognostic study, level II evidence. Purpose To define the normal change in the creatine kinase (CK) levels in patients undergoing prone or supine lumbar or cervical spine surgery and to determine if positioning influences the postoperative changes in the CK levels. Overview of Literature Spine surgery is one of the most commonly performed and fastest growing areas of surgery in the United States. Thus, the various possible complications need to be understood, and risk factors for these complications need to be mitigated. One of the rare complications, reported in the literature as small case series and case reports, is rhabdomyolysis, diagnosed by high CK levels. Thus far, very few studies have examined the rise in CK levels following spine surgery, and to our knowledge, none has assessed the potential association of surgical positioning and the rise in CK levels. Methods We retrospectively analyzed 94 patients. We obtained their preoperative CK levels, and re-assessed their CK levels at postoperative day (POD) 1, 2, and 3, as well as at their 2-week follow-up. The data were analyzed with respect to the spine level and positioning to determine if positioning had any effect on the postoperative rise in the CK level. Results Total 94 consecutive patients were enrolled in this study. The average preoperative CK level was 179.64, and the average CK level was 847.04 on POD 1. Prone positioning showed a greater rise in the CK levels following surgery than the supine positioning. In a similar manner, lumbar procedures led to a larger rise in the CK levels than cervical surgery. Prone/lumbar surgery showed the largest increase among all groups. Finally, revision surgery and instrumentation both increased the postoperative CK levels. Conclusions This study demonstrated that positioning can affect the postoperative CK level rise, with patients undergoing prone/lumbar surgery showing the greatest rise in the postoperative CK levels. This rise, however, may be related to paraspinal muscle damage, rather than the positioning itself.

Anesthetic Management and Neuromonitoring in a Patient with Very Long-Chain Acyl-Coenzyme A Dehydrogenase Deficiency Undergoing Scoliosis Surgery: A Case Report and Review of Literature

“…The few existing reports on managing patients with VLCADD recommend strict intraoperative monitoring of glucose and serum CK levels along with continuous glucose infusions to prevent hypoglycemia [ 12 , 14 ]. Utilizing this strategy, glucose levels ranged from 140 to 200 mg/dL intraoperatively with no significant elevations of CK levels beyond what is expected after a major spine surgery [ 15 ]. Had signs of rhabdomyolysis been evident, we would have decreased surgical stress by increasing our anesthetics, transfusing blood products or increasing energy supply through glucose administration.…”

The role of serum creatine kinase levels in anterior cervical spinal surgery

“…The inclusion criteria included age ≥18 years, primary anterior cervical spinal surgery, including anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF). Exclusion criteria included the presence of traumatic injuries, surgical intervention for underlying infection, tumor or pregnancy, muscle injury or eccentric exercise, or a personal history of rhabdomyolysis, [5] all of which could affect CK level before surgery.…”

Comparison of the Clinical Effect of Simple Nucleotomy for the Treatment of Single-segment Lumbar Disc Herniation Using a Microscope and Percutaneous Transforaminal Endoscope

“…Previous studies have shown that serum CPK levels increased most significantly during lumbar spine fusion surgery but also increased to varying degrees during minimally invasive lumbar spine surgery [17] and generally return to normal levels within a week after surgery [10] . This study showed that on the second day after surgery, the serum CPK contents of the 2 groups were significantly higher than before.…”

“…The content of serum CPK [10] was detected on the second postoperative day. The differences in perioperative indexes, such as operation time, intraoperative bleeding, incision length, number of X-ray fluoroscopies during surgery, length of hospital stay, and recurrence after 1 year (secondary operation) were observed.…”