The C-reactive protein for detection of early infections after lumbar microdiscectomy

Abstract

The tendency for short hospitalization after lumbar microdiscectomy implies the need for early confirmation or disapproval of serious postoperative infections such as spondylodiscitis or deep wound infections. The C-reactive protein (CRP) is a well-known screening parameter for monitoring postoperative infectious complications in other fields. Our objective was to establish the diagnostic significance of CRP-in comparison with ESR and WBC-for monitoring infectious complications after lumbar microdiscectomy. Over a 15 months period we studied prospectively a homogeneous group of N = 400 patients with lumbar disc herniations who were operated on a single level for the first time. CRP, ESR and WBC values were determined in all patients pre-operatively, and on postoperative days 1 and 5. Clinical and laboratory findings were correlated and the diagnostic significance of CRP, ESR and WBC calculated. N = 385 (96%) patients had an uneventful postoperative course. N = 15 (4%) patients developed infectious complications, of which N = 6 (1.5%) were unrelated and N = 9 (2.5%) related to surgery. Evaluation of the laboratory values showed: The CRP baseline is a very individual value of no prognostic relevance. A high postaggression peak is typical and essential as a reference value for only the future time course will disclose any infection. We found 0% false negative and 4% false positive results on day 5. The sensitivity for serial CRP testing was calculated as 100% and specificity as 95.8%. ESR (sensitivity: 78.1%/specificity: 38.1%) and WBC (sensitivity: 21.4%/specificity: 76.8%) both failed to reach such distinct diagnostic significance on day 5. The C-reactive protein has thus proved to be a reliable, simple and economical screening test for infectious complications after lumbar microdiscectomy, superior to classical laboratory parameters.

Acute Phase Proteins – Analysis, Clinical Applications and Potentials

“…CRP response in human diseases Larsson et al, (1992) performed a prospective study focused on CRP levels in 193 patients undergoing 4 types of uncomplicated elective orthopedic procedures and concluded that a normalized CRP response that follows a typical biphasic response indicate an uneventful recovery. Meyer et al (1995), proposed using CRP as a simple, reliable, and inexpensive screening test in detection of early infections after lumbar microdiscectomy. CRP levels are increased in patients with rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis and psoriatic arthritis, giant cell arthritis and rheumatic polymyalgia (Rosa Neto and Carvalho, 2009).…”

Diagnostik und Therapie der thorakalen Spondylodiszitis

“…Das C-reaktive Protein (CRP) zeigt dagegen eine Sensitivität von 64-100% und eine Spezifität von 62-95,8% [5,18]. Postoperativ muss natürlich der Verlauf des CRP, der seinen Gipfel am 2.-3.…”

“…Tag hat und innerhalb von 14 Tagen auf den Normalwert zurückkehrt, berücksichtigt werden [5]. Die weit verbreitete Messung der Blutsenkungsgeschwindigkeit (BSG) hat eine Sensitivität von 78,1-82% und eine Spezifität von 38,1-62% [5,18]. Auch hier ist postoperativ ein Gipfel am 4.…”

Does Spondylodiscitis Follow All Its Parameters? - Report of Three Atypical Cases

“…The incisionis usually unremarkable, and in fact, less than 10% ofsurgical incisions show signs of purulent infection with erythema, drainage, or dehiscence [7] . A rise in CRP values after the aforementioned timeframe correlates highly with the presence of an infection [9] . 3 cases would be reported here who developed post operative infection more than a year after surgery, had atypical organism but with floridinfection, had 1 and ½ years continuing sinus tract discharge after minimally invasive discectomy without biochemical marker changes or systemic signs and symptoms.…”