Summary
The tendency for short hospitalization after lumbar microdiscectomy implies the need for early confirmation or disproval 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 calcualted. 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.
Similar content being viewed by others
References
Andrews D, Lavyne M (1990) Retrospective analysis of microsurgical and standard lumbar discectomy. Spine 14: 239–245
Brant-Zawadzki M, Burke VD, Jeffrey RB (1983) CT in the evaluation of spine infections. Spine 8: 358–364
Claus DR, Osmand AP, Gerwurz H (1976) Radioimmunoassay of human C-reactive protein and levels in normal sera. J Lab Clin Med 87: 120
Cooper EH, Ward AM (1979) Acute phase reactant proteins as aids to monitoring disease. Invest Cell Pathol 2: 293
Dauch WA (1986) Infection of the intervertebral space following conventional and microsurgical operations on the herniated lumbar intervertebral disc. Acta Neurochir (Wien) 82: 43–49
Fouquet B, Goupille P, Jattiot F, Cotty P, Lapierre F, Valat JP, Amouroux J, Benatre A (1992) Discitis after lumbar disc surgery, features of “aseptic” and “septic” forms. Spine 17: 356–358
Frank AM, Trappe A (1990) The role of magnetic resonance imaging (MRI) in the diagnosis of spondylodiscitis. Neurosurg Rev 13: 279–283
Grollmus J, Perkins RK, Russel W (1974) Erythrocyte sedimentation rate as a possible indicator of early disc space infection. Neurochirurgia 17: 30–35
Huber A, Kainz CH, Witzmann A, Beran H, Fischer J (1993) Perioperative elastase-alpha-1 proteinase inhibitor in patients with postoperative intervertebral discitis. Acta Neurochir (Wien) 120: 150–154
Kapp JP, Sybers WA (1979) Erythrocyte sedimentation rate following uncomplicated lumbar disc operations. Surg Neurol 12: 329–330
Kock-Jensen C, Branslund D, Sogaard I (1988) Lumbar disc surgery and variations in c-reactive protein, erythrocyte sedimentation rate and the complement split product C3d. Acta Neurochir (Wien) 90: 42–43
Kotilainen E, Valtonen S, Carlson C (1993) Microsurgical treatment of lumbar disc herniation: follow-up of 237 patients. Acta Neurochir (Wien) 120: 143–149
Mac Leod T, Avery CT (1941) The occurrence during acute infections of a protein not normally present in blood. Immunological properties of the c-reactive protein and its differentiation from normal blood proteins. J Exp Med 73: 191
Nakamura R (1976) Quantitation of “acute phase proteins” postoperatively. Value in detection and monitoring complications. Am J Clin Pathol 66: 840
Onofrio BM (1980) Intervertebral discitis. Incidence, diagnosis and management. In: Carmel DWet al (eds) Clin Neurosurg. Williams and Wilkins, Baltimore, pp 481–516
Peltola H, Räsänen JA (1982) Quantitative C-reactive protein in relation to erythrocyte sedimentation rate, fever and duration of antimicrobial therapy in bacteremic diseases of childhood. J Infection 5: 257–267
Peltola H (1982) C-reactive protein for rapid monitoring of infections of the central nervous system. Lancet 1: 980–983
Peltola H, Holmberg C (1983) Rapidity of C-reactive protein in detecting potential septicemia. Pediatr Infect Dis 2: 374–376
Pepys MB (1981) C-reactive protein fifty years on. Lancet 1: 653–657
Peruzzi P, Rousseaux P, Scherpereel B, Bernhard MH, Bazin A, Baudrillard JC, Graftieaux JP, Colmet Daage JF (1988) Spondylodiscitis after surgery of lumbar disc hernia. Apropos of 12 cases in 1796 operations. Neurochirurgie 34: 394–400
Pilgaard S (1969) Discitis following removal of lumbar intervertebral discs. J Bone Joint Surg 51A: 713–716
Puranen J, Mäkelä J, Lähde S (1984) Postoperative intervertebral discitis. Acta Orthop Scand 55: 461–465
Rawlings CE, Wilkins RH, Gallis HA, Goldner JL, Francis R (1983) Postoperative intervertebral disc space infections. Neurosurgery 13: 371–376
Scherbel AL, Gardner JW (1960) Infections involving the intervertebral disc. JAMA 24: 108–112
Stolke D, Seifert V, Kunz K (1988) Postoperative lumbar intervertebral discitis. A review of a 15-year period and 7493 operations. Z Orthop 126: 666–670
Takenaka Y, Kahan A, Amor B (1986) Experimental autoimmune spondylodiscitis in rats. J Rheumatol 13: 398–400
Thibodeau AA (1968) Closed space infections following removal of lumbar intervertebral disc. J Bone Joint Surg 51A: 713–716
Tillet WS, Goebel WF, Avery OT (1930) Chemical and immunological properties of species-specific carbohydrate of pneumococci. J Exp Med 52: 895–900
Tronnier V, Schneider R, Kunz U, Albert F, Oldenkott P (1992) Postoperative spondylodiscitis: results of a prospective study about the etiology of spondylodiscitis after operation for lumbar disc herniation. Acta Neurochir (Wien) 117: 149–152
Waleczek H, Kozianka J, Everts H (1991) Das C-reaktive Protein zur Früherkennung postoperativer Infektionen nach Knochenoperationen. Chirurg 62: 866–870
Zink PM, Frank AM, Trappe AE (1989) Prophylaxis of postoperative lumbar spondylodiscitis. Neurosurgery 12: 297–303
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Meyer, B., Schaller, K., Rohde, V. et al. The C-reactive protein for detection of early infections after lumbar microdiscectomy. Acta neurochir 136, 145–150 (1995). https://doi.org/10.1007/BF01410617
Issue Date:
DOI: https://doi.org/10.1007/BF01410617