title: Serum creatine kinase and lactate dehydrogenase changes after anterior approaches to the thoracic and lumbar spine.
abstract: Ten patients undergoing anterior approaches to the thoracic and lumbar spine had prospective determinations of serum creatine kinase, lactate dehydrogenase, and their myocardial-associated isoenzymes (CK-MB and the LD-1/LD-2 ratio). None of these patients experienced postoperative myocardial infarction. Skeletal muscle injury associated with anterior spinal surgery resulted in significant elevations of serum CK-MB on postoperative Day 1; however, the LD-1/LD-2 ratio did not change significantly. Although false-positive elevations of serum CK-MB occurred, no patient had a CK-MB value exceeding 50 IU/liter combined with an LD-1/LD-2 ratio exceeding 1.0 (so-called "flipped LD" pattern). In evaluating suspected postoperative myocardial infarction, the authors recommend determining the isoenzymes of both serum creatine kinase and lactate dehydrogenase. In postoperative patients, elevations of CK-MB exceeding 50 IU/liter combined with an LD-1/LD-2 ratio exceeding 1.0 should not be attributed to skeletal muscle injury alone after anterior approaches to the thoracic and lumbar spine.
authors.affiliation: Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, DC.
authors.forename: D K
authors.initials: DK
authors.lastname: Wukich
authors.forename: B E
authors.initials: BE
authors.lastname: Van Dam
authors.forename: G M
authors.initials: GM
authors.lastname: Graeber
authors.forename: T
authors.initials: T
authors.lastname: Martyak
mesh_terms: D000293:Adolescent; D000328:Adult; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000293:injuries*; D009203:Myocardial Infarction / Q000175:diagnosis; D009206:Myocardium / Q000201:enzymology; D011183:Postoperative Complications / Q000175:diagnosis; D013904:Thoracic Vertebrae / Q000601:surgery*
chemical_list: D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase