Sequential Changes of Plasma C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Spine Surgery : Comparison between Lumbar Open Discectomy and Posterior Lumbar Interbody Fusion

Abstract

ObjectiveC-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often utilized to evaluate for postoperative infection. Abnormal values may be detected after surgery even in case of non-infection because of muscle injury, transfusion, which disturbed prompt perioperative management. The purpose of this study was to evaluate and compare the perioperative CRP, ESR, and white blood cell (WBC) counts after spine surgery, which was proved to be non-infection.MethodsTwenty patients of lumbar open discectomy (LOD) and 20 patients of posterior lumbar interbody fusion (PLIF) were enrolled in this study. Preoperative and postoperative prophylactic antibiotics were administered routinely for 7 days. Blood samples were obtained one day before surgery and postoperative day (POD) 1, POD3, and POD7. Using repeated measures ANOVA, changes in effect measures over time and between groups over time were assessed. All data analysis was conducted using SAS v.9.1.ResultsChanges in CRP, within treatment groups over time and between treatment groups over time were both statistically significant F(3,120)=5.05, p=0.003 and F(1,39)=7.46, p=0.01, respectively. Most dramatic changes were decreases in the LOD group on POD3 and POD7. Changes in ESR, within treatment groups over time and between treatment groups over time were also found to be statistically significant, F(3,120)=6.67, p=0.0003 and F(1,39)=3.99, p=0.01, respectively. Changes in WBC values also were be statistically significant within groups over time, F(3,120)=40.52, p<0.001, however, no significant difference was found in between groups WBC levels over time, F(1,39)=0.02, p=0.89.ConclusionWe found that, dramatic decrease of CRP was detected on POD3 and POD7 in LOD group of non-infection and dramatic increase of ESR on POD3 and POD7 in PLIF group of non-infection. We also assumed that CRP would be more effective and sensitive parameter especially in LOD than PLIF for early detection of infectious complications. Awareness of the typical pattern of CRP, ESR, and WBC may help to evaluate the early postoperative course.

Correlation Between Clinical Course and Biochemical Analysis in Odontogenic Space Infections

“…In conclusion, the combination of CRP, ESR and WBC count reliably predicts the clinical course of odontogenic infection [9]. The quantitative determination of these serum markers can be used for determining not only the therapeutic efficacy of different treatment regimens of infection, but also the duration of antibiotic usage becomes more appropriate with them.…”

“…On day 7, a significant correlation between mouth opening and ESR showed that ESR is a late indicator of clinical state of the patient. Though the patients were markedly improved by day 7, the time taken for normalization of WBC count was 4 days on an average and for CRP between 7 and 14 days, but ESR had not fallen back to normal level even on day 14 thereby indicating persistent inflammatory state which further means that body needs nutritional support till this time [9].…”

Changes of Biomarkers before and after Antibiotic Treatment in Spinal Infection

“…Although ESR has a low specificity for diseases, it is used to diagnose and follow up various cases, including infection, inflammatory diseases, malignant tumor, and trauma. Due to its non-specificity, ESR is used to evaluate the activity of a given disease or monitor its progression, rather than its diagnosis 41618). CRP increases in response to pneumococcal infection, stress, trauma, infection, inflammation, postoperative changes, and tumor, and has a higher sensitivity compared to other acute-phase reactive proteins 416).…”

“…Due to its non-specificity, ESR is used to evaluate the activity of a given disease or monitor its progression, rather than its diagnosis 41618). CRP increases in response to pneumococcal infection, stress, trauma, infection, inflammation, postoperative changes, and tumor, and has a higher sensitivity compared to other acute-phase reactive proteins 416). PCT is a peptide consisting of 116 amino acids and is produced by parafollicular cells of the thyroid gland 5920).…”

“…Spinal infection is diagnosed through physical examination, laboratory tests, or radiologic studies. Typical laboratory tests performed to diagnose spinal infection include white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) 345101112141516)…”