C-reactive protein in spinal surgery: more predictive than prehistoric

Eur Spine J. 2021 May;30(5):1261-1269. doi: 10.1007/s00586-021-06782-8. Epub 2021 Mar 7.


Purpose: In spinal surgery, surgical site infections (SSI) after dorsal spondylodesis lead to severe short- and long-term complications. Despite various clinical and serological evidence, the detection of a postoperative SSI remains crucial. In this retrospective cohort study, we determined the prognostic value of C-reactive protein (CRP) kinetics after open reduction and dorsal spondylodesis in the development of a SSI.

Methods: We retrospectively analyzed 192 patients from 2016 to 2018 undergoing open reduction and dorsal spondylodesis with and without SSI for 20 days at a level-I trauma center and assessed their serological and clinical characteristics.

Results: On day 7 and 8 after surgery, patients who developed a SSI displayed significantly higher CRP levels. A second peak after the initial maximum of CRP and a restricted failure to decline as well as a maximum CRP of more than 225 mg/l predict an infectious complication with a sensitivity of 92.9%, and a specificity of 78.2%. A binary logistic regression leads to 85.7% and 69.7%, respectively. A one-phase decay exponential regression can predict 75.6% of the variance after the initial peak of CRP.

Conclusion: Our study demonstrates a high value of postoperative CRP kinetics in SSI detection after dorsal spondylodesis. Moreover, we observed typical CRP levels with a specific course as indicative predictors that may facilitate an early SSI detection in clinical practice.

Keywords: C-reactive protein; Dorsal spondylodesis; Revision surgery; Spinal surgery; Surgical site infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • C-Reactive Protein* / analysis
  • Humans
  • Neurosurgical Procedures
  • Predictive Value of Tests
  • Retrospective Studies
  • Surgical Wound Infection*


  • C-Reactive Protein