J Korean Neurosurg Soc.  2014 Sep;56(3):218-223. 10.3340/jkns.2014.56.3.218.

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

• Choi MK
• Kim SB
• Kim KD
• Ament JD

• KMID: 2339960
• DOI: http://doi.org/10.3340/jkns.2014.56.3.218

Abstract

OBJECTIVE
C-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.
METHODS
Twenty 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.
RESULTS
Changes 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.
CONCLUSION
We 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.

Keyword

Open discectomy; Posterior lumbar interbody fusion; Postoperative infection; C-reactive protein; Erythrocyte sedimentation rate; White blood cell

MeSH Terms

Anti-Bacterial Agents
Blood Sedimentation*
C-Reactive Protein*
Diskectomy*
Humans
Leukocyte Count*
Leukocytes
Plasma*
Spine*
Statistics as Topic
Anti-Bacterial Agents
C-Reactive Protein

Figure

• 

  Fig. 1 The changes of mean CRP (A), ESR (B), and WBC (C) on preoperative and postoperative 1, 3, and 7 days comparing between Group A and B according to the postoperative day. Group A : open lumbar discectomy, Group B : posterior lumbar interbody fusion. In group A, mean CRP was normalized rapidly at postoperative 3rd day. While mean CRP of Group B show-ed steady decrease and mean CRP did not normalized to preoperative state even in POD 7th day (A). Mean ESR level changes in both group A, B showed decrease on the 1st postoperative day, and then clearly elevated above its preoperative levels on the 3rd postoperative day, showing steady increase until 7th postoperative day (B). Both group A, B of mean WBC count elevated rapidly on 1st postoperative day, and then decreased to normalize after 3rd postoperative day (C). CRP : C-reactive protein, ESR : erythrocyte sedimentation rate, WBC : white blood cell, POD : postoperative day.

• 

  Fig. 2 The scattered pattern of CRP (A), ESR (B), and WBC (C) on preoperative and postoperative 1, 3, and 7 days in Group A according to the postoperative day. Group A : open lumbar discectomy. CRP : C-reactive protein, ESR : erythrocyte sedimentation rate, WBC : white blood cell, POD : postoperative day.

• 

  Fig. 3 The scattered pattern of CRP (A), ESR (B), and WBC (C) on preoperative and postoperative 1, 3, and 7 days in Group B according to the postoperative day. Group B : posterior lumbar interbody fusion. CRP : C-reactive protein, ESR : erythrocyte sedimentation rate, WBC : white blood cell, POD : postoperative day.

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