title: 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.
authors: Department of Neurosurgery, Klinikum Kalkweg, Duisburg, Federal Republic of Germany.
authors: B
authors: B
authors: Meyer
authors: K
authors: K
authors: Schaller
authors: V
authors: V
authors: Rohde
authors: W
authors: W
authors: Hassler
mesh_terms: D000293:Adolescent; D000328:Adult; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D017586:Diskectomy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007958:Leukocyte Count; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000175:diagnosis*
chemical_list: D002097:C-Reactive Protein