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Impact of Spinal Instrumentation on Early Postoperative Inflammatory Markers: A Comparative Analysis in the Same
Hiroyuki Aono1, Shota Takenaka2, Yukitaka Nagamoto3
1Department of Orthopedic Surgery, Osaka Global Orthopedic Hospital, Osaka, Japan.
Background:
Postoperative inflammatory parameters are important markers of surgical site infection. Some authors have reported that spine surgery with instrumentation elevates C-reactive protein (CRP) levels more than that without instrumentation does. However, those studies compared early postoperative inflammatory markers with or without instrumentation in different patients, although CRP levels vary widely among patients. Therefore, we investigated the impact of early postoperative inflammatory reaction with or without instrumentation in the same patients.
Methods:
Data were examined for 72 patients who had undergone lumbar surgery twice, once with instrumentation and once without instrumentation. CRP level, white blood cell (WBC) count, and neutrophil count (NC) were measured before surgery and at 1, 3, 7, and 14 days after surgery. All surgeries with instrumentation were posterior lumbar interbody fusion (PLIF) and all without instrumentation were laminotomy.
Results:
Comparison of peak CRP between procedures with instrumentation and those without instrumentation showed a consistent peak on day 3 for all patients across both types of surgical procedures. After PLIF, there was a significantly elevated CRP, WBC, and NC in comparison to these for laminotomy. There were significant interactions between time and PLIF in relation to CRP, WBC, and NC levels. There were significant interactions between time and number of levels in relation to CRP and NC. Age, gender, blood loss, and duration of surgery did not influence the observed elevations of all markers.
Conclusions:
Early postoperative trends were significantly higher after PLIF than after laminotomy for all three indices, with a significant interaction between time and number of levels for CRP and NC.
