Department of Orthopaedics, Trauma Surgery and Hand Unit, 27664Helios Klinikum Krefeld, Krefeld, Germany.
Department of Radiology, 31098Zuger Kantonsspital AG, Baar, Switzerland.
J Orthop Surg (Hong Kong). 2021 Jan-Apr;29(1):2309499020968296. doi: 10.1177/2309499020968296.
C-reactive protein (CRP) and white blood cell (WBC) count are routine blood chemistry parameters in monitoring infection. Little is known about the natural history of their serum levels in conservative and operative spondylodiscitis treatment.
Pre- and postoperative serum levels of CRP and WBC count in 145 patients with spondylodiscitis were retrospectively assessed. One hundred and four patients were treated by debridement, spondylodesis, and an antibiotic regime, 41 only with a brace and antibiotics. The results of the surgical group were compared to 156 patients fused for degenerative disc disease (DDD).
Surgery had a significant effect on peak postoperative CRP levels. In surgically managed patients, CRP peaked at 2-3 days after surgery (spondylodiscitis: pre-OP: 90 mg/dl vs. post-OP days 2-3: 146 mg/dl; DDD: 9 mg/dl vs. 141 mg/dl; < 0.001), followed by a sharp decline. Although values were higher for spondylodiscitis patients, dynamics of CRP values were similar in both groups. Nonoperative treatment showed a slower decline. Surgically managed spondylodiscitis showed a higher success rate in identifying bacteria. Specific antibiotic treatment led to a more predictable decline of CRP values. WBC did not show an interpretable profile.
CRP is a predictable serum parameter in patients with spondylodiscitis. WBC count is unspecific. Initial CRP increase after surgery is of little value in monitoring infection. A preoperative CRP value, and control once during the first 3 days after surgery is sufficient. Closer monitoring should then be continued. Should a decline not be observed, therapy needs to be scrutinized, antibiotic treatment reassessed, and concomitant infection contemplated.
C-反应蛋白（CRP）和白细胞（WBC）计数是监测感染的常规血液生化参数。关于保守和手术治疗的脊椎炎患者其血清水平的自然史知之甚少。
回顾性评估了 145 例脊椎炎患者的 CRP 和 WBC 计数的术前和术后血清水平。104 例患者接受清创术、脊椎融合术和抗生素治疗，41 例仅接受支具和抗生素治疗。将手术组的结果与 156 例退行性椎间盘疾病（DDD）融合患者进行比较。
手术对术后 CRP 峰值水平有显著影响。在接受手术治疗的患者中，CRP 在术后 2-3 天达到峰值（脊椎炎：术前：90mg/dl vs. 术后 2-3 天：146mg/dl；DDD：9mg/dl vs. 141mg/dl；<0.001），随后急剧下降。虽然脊椎炎患者的数值更高，但两组 CRP 值的变化趋势相似。非手术治疗下降较慢。手术治疗的脊椎炎患者能更准确地鉴定细菌。针对特定细菌的抗生素治疗能更准确地预测 CRP 值的下降。WBC 没有表现出可解释的模式。
CRP 是脊椎炎患者的一个可预测的血清参数。WBC 计数无特异性。术后 CRP 初始增加对监测感染的价值不大。术前 CRP 值和术后前 3 天内的一次检测即可。然后应继续密切监测。如果未观察到下降，则需要仔细检查治疗，重新评估抗生素治疗，并考虑合并感染的可能性。
