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

Acta Neurochir (Wien). 1995;136(3-4):145-50. doi: 10.1007/BF01410617.

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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Blood Sedimentation
  • C-Reactive Protein / analysis*
  • Diskectomy*
  • Female
  • Humans
  • Intervertebral Disc Displacement / surgery*
  • Leukocyte Count
  • Male
  • Microsurgery*
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Reference Values
  • Sensitivity and Specificity
  • Surgical Wound Infection / diagnosis*

Substances

  • C-Reactive Protein