Neurological Recovery Determined by C-Reactive
Protein, Erythrocyte Sedimentation Rate and
Two Different Posterior Decompressive Surgical
Procedures: A Retrospective Clinical Study of
Patients with Spinal Tuberculosis
Weera Sudprasert MD*,
Urawit Piyapromdee MD*, Supphamard Lewsirirat MD*
Affiliation :
* Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Background : C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) not only are useful in the diagnosis but
also are reliable parameters in evaluating the response to treatment and prognosis of tuberculous spondylodiscitis.
Objective : To analyze the correlation between neurological recovery and declination of CRP or ESR after two different
posterior spinal procedures.
Material and Method: The patients who had neurological deficit due to spinal tuberculosis and undergone spinal surgery
between January 2009 and June 2013 were analyzed retrospectively. Posterior transforaminal decompression and interbody
fusion were done in group I, whereas posterior transpedicular decompression and posterolateral fusion were performed on
group II. Both groups were stabilized with pedicle screw instrumentation. Rapid recovery represented by improvement of
at least one Frankel grade within 6 weeks after operation, otherwise it was slow recovery. Inflammatory markers were
evaluated at initial diagnosis and at 6-week, 3-month, 6-month, and 1-year post-operation.
Results : There were 31 patients. Group I included 14 cases and group II consisted of 17 cases. The median CRP and ESR
at diagnosis were 80.4 mg/L and 78.0 mm/hour respectively. Rapid neurological recovery significantly related to the earlier
declination of CRP within the first 6 weeks (p<0.001). Considering the type of spinal procedures especially at thoracic and
thoracolumbar level, neurological recovery in group I was significantly faster than in group II (p = 0.02; relative risk, 2.67;
95% confidence interval, 1.02 to 6.91).
Conclusion : Earlier declination of CRP within six weeks post-operation could determine rapid neurological recovery.
Posterior transforaminal decompression and interbody fusion with instrumentation may be a suitable option for thoracic
and thoracolumbar lesions.
Keywords : Neurological recovery, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Transforaminal
decompression, Transpedicular decompression, Spinal tuberculosis
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