title: CRP and leukocyte-count after lumbar spine surgery: fusion vs. nucleotomy.
abstract: BACKGROUND
  Despite the fact that C-reactive protein (CRP) levels and white blood cell (WBC) count are routine blood chemistry parameters for the early assessment of wound infection after surgical procedures, little is known about the natural history of their serum values after major and minimally invasive spinal procedures.
  
  
  METHODS
  Pre- and postoperative CRP serum levels and WBC count in 347 patients were retrospectively assessed after complication-free, single-level open posterior lumbar interlaminar fusion (PLIF) (n = 150) for disc degeneration and spinal stenosis and endoscopically assisted lumbar discectomy (n = 197) for herniated lumbar disc. Confounding variables such as overweight, ASA classification, arterial hypertension, diabetes mellitus, and perioperative antibiotics were recorded to evaluate their influence on the kinetics of CRP values and WBC count postoperatively.
  
  
  RESULTS
  In both procedures, CRP peaked 2-3 days after surgery. The maximum CRP level was significantly higher after fusion: mean 127 (SD 57) (p < 0.001). A rapid fall in CRP within 4-6 days was observed for both groups, with almost normal values being reached after 14 days. Only BMI > 25 and long duration of surgery were associated with higher peak CRP values. WBC count did not show a typical and therefore interpretable profile.
  
  
  CONCLUSIONS
  CRP is a predictable and responsive serum parameter in postoperative monitoring of inflammatory responses in patients undergoing spine surgery, whereas WBC kinetics is unspecific. We suggest that CRP could be measured on the day before surgery, on day 2 or 3 after surgery, and also between days 4 and 6, to aid in early detection of infectious complications.
authors.affiliation: Department of Orthopaedics, Trauma Surgery and Hand Unit, Helios Klinikum, Krefeld, Germany. clayton.kraft@helios-kliniken.de
authors.forename: Clayton N
authors.initials: CN
authors.lastname: Kraft
authors.forename: Tobias
authors.initials: T
authors.lastname: Krüger
authors.forename: Jörn
authors.initials: J
authors.lastname: Westhoff
authors.forename: Christian
authors.initials: C
authors.lastname: Lüring
authors.forename: Oliver
authors.initials: O
authors.lastname: Weber
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Wirtz
authors.forename: Peter H
authors.initials: PH
authors.lastname: Pennekamp
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000032:analysis*; D017587:Diskectomy, Percutaneous / Q000009:adverse effects; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery; D007958:Leukocyte Count; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D013130:Spinal Stenosis / Q000601:surgery; D013530:Surgical Wound Infection / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein