Despite many advances in spine surgery in recent years, postoperative infections still occur in anywhere from 1% to 12% of all spinal surgery patients. To determine the percentage of post-operative infection among the patients of Consulting Orthopedists and to attempt to find ways to reduce the occurrence of infection, Consulting Orthopedists has conducted a research study whose results are summarized in a research paper entitled:

ERYTHROCYTE SEDIMENTATION RATE AND C-REACTIVE PROTEIN AS A PREDICTOR FOR POSTOPERATIVE SPINE INFECTION IN SCOLIOSIS AND KYPHOSIS CORRECTIVE SURGERY

Post-operative spinal surgery infections typically manifest with symptoms of wound swelling, erythema (inflammation of the skin), and drainage. We know generally from experience and from the reported literature that the duration of the surgical procedure, patient comorbidities (other maladies suffered by the patient) and the nutritional status of the patient are all directly related to the infection rate. Prophylactic antibiotic therapy has been shown to decrease the infection rate.

When inflammation is present in the body, certain proteins are produced by the liver and the immune system that cause red blood cells (erythrocytes) to stick together and fall more quickly than normal to the bottom of a test tube (sedimentation rate). The same is true for cardio-reactive protein or CRP.
Higher-than-normal levels of CRP may indicate inflammation.

In uncomplicated spinal surgery, CRP levels peak at 2-3 days postoperatively and tend to normalize between 5 and 14 days. SED rate levels peak on day 5 but decline at an inconsistent rate. In surgeries where infection occurs, CRP and SED rates may be elevated beyond these levels.

To determine the relationship between CRP levels, SED rates and post-operative infections, all Consulting Orthopedists patients undergoing spinal surgery, were studied with CRP and SED rates pre-operatively, then at discharge, at 4 weeks, at 6 weeks, and finally at 12 weeks post-operatively.

The results of the study showed that 7.69% of Consulting Orthopedists patients developed post-operative infection. Of the 92.31% who did not develop infections, CRP levels were measured at -0.24 and the SED rate was -0.22, whereas those who did develop infections recorded CRP levels of -0.26 and a SED rate of -0.55.

While this study did not encompass a large enough number of subjects for true statistical relevance, the results do indicate that CRP is neither specific nor sensitive for postoperative spinal infection but SED rates showed positive correlation with postoperative spinal infection - and points the way for further research into erythrocyte and sedimentation rates as a post operative indicator for possible antibiotic therapy.

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