Schneider T, Wildförster U, Diekmann J
Department of Neurosurgery, University of Bochum, Knappschaftskrankenhaus, Federal Republic of Germany.
Acta Neurochir (Wien). 1995;136(1-2):16-20. doi: 10.1007/BF01411430.
The diagnosis of spondylodiscitis after lumbar disc surgery has been based so far on clinical abnormalities, non-specific changes in chemical laboratory parameters [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] and radiological examinations such as MRI. Such techniques do not enable any clear diagnosis to be made before the 3rd postoperative week. The PMN elastase released from stimulated polymorphonuclear granulocytes has been proved to be a good laboratory parameter by which it is possible to prognosticate bacterial and abacterial organ complications in surgical patients with a high degree of probability. Under investigation were 12 patients with spondylodiscitis out of 1162 operations on herniated lumbar discs. PMN elastase was determined on the 7th postoperative day. In patients with spondylodiscitis and a mean value of 110.5 micrograms/l, the elastase was on average higher by a factor of 2.6 as compared to 88 randomly selected control patients. Since spondylodiscitis is a rare complication, this results in a positive value of only 7%, which does not allow a reliable diagnosis of spondylodiscitis by the elastase assay. But because the negative predictive value is 100%, it is possible to exclude a postoperative spondylodiscitis already on the 7th postoperative day, if the elastase value is normal.
迄今为止，腰椎间盘手术后脊椎椎间盘炎的诊断一直基于临床异常情况、化学实验室参数（红细胞沉降率（ESR）、C反应蛋白（CRP））的非特异性变化以及诸如MRI等影像学检查。此类技术在术后第3周之前无法做出任何明确诊断。已证明，从受刺激的多形核粒细胞释放的PMN弹性蛋白酶是一个良好的实验室参数，通过该参数可以高度准确地预测外科手术患者的细菌性和非细菌性器官并发症。在1162例腰椎间盘突出症手术患者中，有12例患有脊椎椎间盘炎并接受了调查。在术后第7天测定PMN弹性蛋白酶。患有脊椎椎间盘炎的患者，其弹性蛋白酶平均值为110.5微克/升，与88例随机选择的对照患者相比，弹性蛋白酶平均高出2.6倍。由于脊椎椎间盘炎是一种罕见的并发症，这导致仅7%的检测结果呈阳性，因此无法通过弹性蛋白酶检测对脊椎椎间盘炎做出可靠诊断。但由于阴性预测值为100%，如果弹性蛋白酶值正常，在术后第7天就可以排除术后脊椎椎间盘炎。
