Early-phase enhanced inflammatory reaction after spinal instrumentation surgery

Study Design. The erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and body temperature were measured prospectively in pati ents after two types of spinal surgery without complications and three case s of infection after spinal instrumentation surgery. Objectives. To investigate the effects of instrumentation on postoperative inflammatory reaction, and to describe early detection of postoperative wou nd infection. Summary of Background Data. In thoracic and abdominal surgery as well as hi p arthroplasty, C-reactive protein has proved more valuable than erythrocyt e sedimentation rate for early detection of postoperative infectious compli cations. It has not yet been established, however, how inflammatory paramet ers change after surgery when spinal instruments have been inserted into th e body. Methods. For this study, two groups of patients were examined: a control gr oup that underwent spinal decompression surgery without instrumentation (n = 36) and another group that underwent spinal decompression and fusion surg ery with spinal instrumentation (n = 37). The erythrocyte sedimentation rat e, C-reactive protein, white blood cell count, and body temperature were re corded 1 day before surgery and on days 0 to 4, 7, 11, 14, 21, 28, and 42 a fter surgery. Results. Inflammatory indexes (i.e., C-reactive protein, erythrocyte sedime ntation rate, white blood cell count, and body temperature) were significan tly higher for the surgery with instrumentation than for the spinal decompr ession surgery without instrumentation. Multiple regression analysis showed that C-reactive protein and erythrocyte sedimentation rate peaks significa ntly correlated with the use of instrumentation (C-reactive protein: P = 0. 000257, erythrocyte sedimentation rate: P = 0.000132). In the patients with infection after spinal instrumentation surgery, C-reactive protein, white blood cell count, and body temperature started to increase again 4 to 11 da ys after surgery. The elevation of erythrocyte sedimentation rate levels wa s prolonged. Conclusions. Erythrocyte sedimentation rate and C-reactive protein display a significantly higher reaction after spinal surgery with instrumentation. Renewed elevation of C-reactive protein, white blood cell count, and body t emperature after postoperative days 4 to 7 may be a critical sign of postop erative infection.