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Inc eased in e leukin-6 and C- eac i e p o ein le els a e ins umen ed lumba spine
usion in olde pa ien s
© Au ho s, 2019
Published e sion
Repo, Jussi P.; Häkkinen, A ja; Po kka, Tuukka; Häkkinen, Keijo; Kau iainen,
Hannu; Ky ölä, Ka i; Ne a, Ma ko H.
Repo, J. P., Häkkinen, A., Po kka, T., Häkkinen, K., Kau iainen, H., Ky ölä, K., & Ne a, M. H.
(2019). Inc eased in e leukin-6 and C- eac i e p o ein le els a e ins umen ed lumba spine
usion in olde pa ien s. Jou nal o O hopaedic Su ge y, 27(1), 1-6.
h ps://doi.o g/10.1177/2309499019826406
2019
A icle
Inc eased in e leukin-6 and C- eac i e
p o ein le els a e ins umen ed
lumba spine usion in olde pa ien s
Jussi P Repo
1
, A ja H Ha
¨kkinen
2
, Tuukka Po kka
3
,
Keijo Ha
¨kkinen
4
, Hannu Kau iainen
5
, Ka i Ky o
¨la
¨
1
and
Ma ko H Ne a
3
Abs ac
Pu pose: In e leukin 6 (IL-6) and he acu e phase C- eac i e p o ein (CRP) blood concen a ions a e lumba spine
usion may be a ec ed by age. The pu pose o his p ospec i e obse a ional s udy was o assess pos ope a i e se um
le els o p o-in lamma o y IL-6 and CRP a e ins umen ed lumba spine usion su ge y. We hypo hesized ha olde
pa ien s would ha e inc eased le els o IL-6 and CRP a e su ge y. Me hods: IL-6 and high-sensi i e CRP biochemical
ma ke le els we e measu ed be o e ins umen ed spinal usion, and pos ope a i ely a 1 and 3 days, 6 weeks, and
3 mon hs. The 49 pa ien s in his sample we e di ided in o wo g oups: age 60 yea s (n¼23) and age > 60 yea s
(n¼26). Resul s: Acu e changes in IL-6 high-sensi i i y and CRP om p eope a i e le els o pos ope a i e day (POD) 1
inc eased wi h age. Mean (95% CI) di e ence be ween he age-g oups in changes o IL-6 a PODs 1 and 3 was 45 pg/ml
(10–83, p¼0.014) and 20 pg/ml (5–36, p¼0.021), espec i ely. Mean (95% CI) di e ence be ween g oups in changes o
CRP a PODs 1 and 3 was 9.6 mg/l (3.5 o 22.7, p¼0.47) and 24.8 mg/l (17 o 67, p¼0.33), espec i ely. Bo h g oups
had dec eased IL-6 and CRP le els a 6 weeks a e su ge y compa ed o he p eope a i e le el. Conclusions: Ele a ion
o IL-6 and CRP is s onge in pa ien s o e 60 yea s old a e ins umen ed lumba spinal usion. The CRP and IL-6 a e
sensi i e ma ke s o acu e pos ope a i e in lamma ion. E en high acu e CRP alues do no necessa ily indica e pos -
ope a i e in ec ion.
Keywo ds
C- eac i e p o ein, usion, in e leukin-6, lumba , spine, su ge y
Da e ecei ed: 25 Janua y 2018; Recei ed e ised 10 Oc obe 2018; accep ed: 3 Janua y 2019
In oduc ion
Spinal pa hologies can cause signi ican pain and impai -
men . In se e e lumba spine pa hologies and cases whe e
conse a i e ea men has ailed, spinal usion in combi-
na ion wi h decomp ession can dec ease he le el o dis-
abili y and pain as well as inc ease pa ien s’ heal h- ela ed
quali y o li e.
1–3
Howe e , su gical auma ac i a es endo-
c ine, me abolic, and in lamma o y esponses.
4
Local
in ec ion con ol and healing p ocess a e spinal usion is
achie ed h ough he in lamma o y esponse whe e p o-
in lamma o y cy okines p omo e healing. One o hese
cy okines is in e leukin 6 (IL-6), which is p oduced by cells
1
Depa men o Su ge y, Cen al Finland Heal h Ca e Dis ic , Jy a
¨skyla
¨,
Finland
2
Heal h Sciences, Facul y o Spo and Heal h Sciences, Uni e si y o
Jy a
¨skyla
¨, Jy a
¨skyla
¨, Finland
3
Depa men o O hopaedic and T auma Su ge y, Tampe e Uni e si y
Hospi al, Tampe e, Finland
4
Biology o Physical ac i i y, Facul y o Spo and Heal h Sciences,
Uni e si y o Jy a
¨skyla
¨, Finland
5
Depa men o Gene al P ac ice, Uni e si y o Helsinki and Helsinki
Uni e si y Hospi al, HUS, Finland
Co esponding au ho :
Jussi P Repo, Depa men o Su ge y, Cen al Finland Heal h Ca e
Dis ic , Keskussai ai aalan ie 19, 40620 Jy a
¨skyla
¨, Finland.
Email: [email p o ec ed]
Jou nal o O hopaedic Su ge y
27(1) 1–6
ªThe Au ho (s) 2019
A icle euse guidelines:
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DOI: 10.1177/2309499019826406
jou nals.sagepub.com/home/osj
Jou nal o
O hopaedic
Su ge
y
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in he immune sys em.
5,6
IL-6 unc ions in media ing sys-
emic in lamma ion ha induces he p oduc ion o acu e
phase C- eac i e p o ein (CRP) in li e hepa ocy es.
7–10
A ise in se um IL-6 and CRP concen a ion ollowing
spinal su ge y co ela es wi h he magni ude o issue
auma caused by he p ocedu e.
11–15
Biochemical ma ke
concen a ions a e highe in pa ien s a e ins umen ed
spinal usion han hey a e in pa ien s wi hou ins umen a-
ion.
9,10
CRP le els a e widely used also o de ec ing su -
gical si e in ec ion a e spinal usion.
10,16–18
In addi ion o su gical auma and in ec ion, he pa ien ’s
age may in luence he in ensi y o he in lamma o y
esponse. Inc eased le els o CRP, IL-6, and umo nec o-
sis ac o alpha can be ound in heal hy olde indi iduals
compa ed wi h younge pe sons.
19,20
IL-6 esponse a e
hip su ge y inc eases wi h olde age.
21
Age- ela ed p o-
in lamma o y s a e can be caused by ca dio ascula isk
ac o s and inc eased mo bidi y wi h aging.
20
Fu he mo e,
accumula ion o in a-abdominal adipose issue ele a es
IL-6 and CRP le els in olde people.
22
Howe e , no da a
ha e been a ailable on he in e ac ions be ween IL-6 and
CRP le els wi h age in pa ien s who ha e unde gone ins u-
men ed lumba spinal usion. A e lumba spinal usion,
hese ma ke s migh be a ec ed by age.
The aim o his s udy was o assess whe he inc eased
pos ope a i e IL-6 and CRP se um le els a e ins umen-
ed lumba spinal usion su ge y a e ela ed o age.
Ma e ials and me hods
This s udy hypo hesized ha olde pa ien s would ha e
inc eased le els o CRP and high-sensi i i y C- eac i e
p o ein (hs-CRP) a e ins umen ed lumba usion su -
ge y compa ed o hose o younge pa ien s. Pa ien s
aged 18 o mo e wi h success ul blood samples we e
included. Pa ien s wi h in lamma o y diseases o se e e
ca dio ascula , psychia ic, social, o gene al heal h dis-
o de s we e excluded om his s udy. Resul s a e
epo ed adhe ing o he S eng hening he Repo ing
o Obse a ional S udies in Epidemiology (STROBE)
s a emen . The e hics commi ee o Tampe e Uni e si y
Hospi al app o ed he s udy p o ocol.
Pa ien s
Al oge he 52 consecu i e pa ien s who unde wen an elec-
i e ins umen ed lumba spine usion and decomp ession a
Tampe e Uni e si y Hospi al we e ec ui ed o he s udy. All
pa icipan s signed an in o med consen . Blood samples we e
collec ed success ully om 49 o he 52 pa ien s: 3 spinal
s enosis pa ien s, 11 is hmic spondylolis hesis pa ien s, and
35 degene a i e spondylolis hesis pa ien s. Diagnosis was
based on magne ic esonance imaging ob ained o pa ien s
in a supine posi ion and plain adiog aphs ob ained in a s and-
ing posi ion. The main indica ion o su ge y was adicula
lowe ex emi y pain. All pa ien s unde wen ea men wi h
ins umen ed open pos e ola e al lumba spine usion using a
midline app oach. The leng h o he usion was one o wo
le el usion o 35 pa ien s and mo e han wo le els o 14
pa ien s. In addi ion, ans o aminal lumba in e body usion
was used in 12 pa ien s. Pa ien s we e di ided in o wo
g oups: age 60 yea s and age > 60 yea s (Table 1). Pa ien s
did no ecei e glucoco icoid o immunomodula o y medi-
ca ion du ing he ollow-up. The e we e no pos ope a i e
in ec ions in he s udy g oup du ing he 3 mon hs’ ollow-
up ime based on clinical obse a ions. All ope a ions we e
pe o med unde gene al anes hesia.
Ques ionnai e compila ion
Pa icipan s we e asked abou he du a ion o hei p eo-
pe a i e symp oms, back pain, and adicula pain a he
ime o admission. In addi ion o pa icipan s’ sociodemo-
g aphic da a, he ques ionnai e add essed heigh , weigh ,
medical condi ions, cu en medica ion, obacco use, and
ecei ed ea men s. The Finnish e sion o he Oswes y
disabili y index (ODI)
23
was used o assess pa icipan s’
back-speci ic disabili y le el.
Blood samples
Blood samples we e collec ed p e- and pos ope a i ely
be ween Ap il 2010 and No embe 2011 a Tampe e Uni-
e si y Hospi al. All samples we e collec ed in he mo ning
be o e b eak as ( as ing blood es s): be o e su ge y as
Table 1. Pa icipan s’ clinical and sociodemog aphic da a.
Age
pValue
60 yea s
(n¼23)
>60 yea s
(n¼26)
Age (yea s), mean (SD) 52.2 (6.6) 71.0 (6.1) <0.001
Female, n(%) 15 (65) 21 (81) 0.33
BMI 29.4 (5.4) 28.1 (5.3) 0.42
Smoke s, n(%) 5 (22) 1 (4) 0.086
P eope a i e symp oms,
mon hs, median (IQR)
24 (15) 24 (23) 0.56
Back pain (VAS) (mon hs),
median (IQR)
57 (37) 64 (52) 0.29
Radicula ing pain (VAS)
(mon hs), median (IQR)
44 (29) 72 (46) 0.018
ODI sco e, mean (SD) 45 (14) 41 (13) 0.28
Diagnosis, n(%) < 0.001
Degene a i e olis hesis 12 (52) 23 (88)
Spinal s enosis 0 (0) 3 (12)
Is hmic spondylolis hesis 11 (48) 0 (0)
Du a ion o he su ge y (min),
mean (SD)
162 (39) 148 (41) 0.24
Blood loss (ml), mean (SD) 390 (182) 442 (413) 0.67
Du al ea s, n(%) 4 (17) 3 (12) 0.69
Leng h o he usion > 2 le els,
n(%)
3 (13) 11 (42) 0.030
IQR: in e qua ile ange; SD: s anda d de ia ion; VAS: isual analogue scale.
2Jou nal o O hopaedic Su ge y 27(1)
well as a e su ge y on PODs 1 and 3 a he hospi al wa d,
and 6 weeks and 3 mon hs pos ope a i ely in a ollow-up a
he ou pa ien clinic. Blood was d awn om he an eb a-
chial ein in o se um acuum ubes. Se um samples we e
s o ed a 80C un il assayed wi h he Immuli e1000 ana-
lyze (Siemens Heal hinee s Global, Siemens Heal hca e
GmbH, E langen, Ge many). Le els o IL-6 and hs-CRP
we e measu ed. The hs-CRP accu a ely measu es low
concen a ions o CRP. I can, he e o e, be used o accu-
a e assessmen o in lamma ion le el. Blood samples
we e analyzed using Immuli e1000 High Sensi i i y CRP
es
®
and Immuli e1000 IL6 es
®
. Measu ing anges we e
0.1–60,000 pg/ml o IL-6 and 0.1–3780 mg/l o hs-CRP.
The de ec ion limi s we e 2 pg/ml o IL-6 and 0.1 mg/l
o hs-CRP.
S a is ics
Da a a e p esen ed as means wi h s anda d de ia ions (SD),
medians wi h in e qua ile anges (IQR), 95%con idence
in e als (95%CI), o as coun s wi h pe cen ages. Repea ed
measu es o con inuous ou comes (IL-6 and CRP) we e
analyzed using a gene alized es ima ing equa ions (GEE)
model wi h he uns uc u ed co ela ion s uc u e. A possi-
ble nonlinea ela ionship be ween age and he IL-6 o he
hs-CRP alues we e assessed using 5-kno - es ic ed cubic
spline eg ession. Models included baseline alue, sex, and
du a ion o he su ge y as co a ia es. In cases whe e he
assump ions we e iola ed (e.g. non-no mali y), a
boo s ap- ype me hod was used (10,000 eplica ions) o
es ima e he s anda d e o . The no mali y o a iables
was e alua ed by he Shapi o–Wilk W es . Di e ence
o one and a leas wo-le el usion was assessed using
he Mann–Whi ney U es . All analyses we e pe o med
using STATA 14.1.
Resul s
Pa ien de ails
The pa ien s’ mean age was 71.8 yea s ( ange 49–93). Thi -
een pa ien s we e male and 36 emale. The mean (SD)
body mass index (BMI) was 28.7 (5.3). The e was no sig-
ni ican di e ence in BMI, gende , o he amoun o smo-
ke s be ween he age-g oups (Table 1). Howe e , pa ien s
olde han 60 yea s had longe pe iods o adia ing leg pain
be o e ope a ion han did pa ien s younge han 60 yea s
(Table 1). Conce ning he ope a ion, he e we e no signi -
ican di e ences be ween he wo g oups in he du a ion o
he su ge y, blood loss, o amoun o du al ea s (Table 1).
Biochemical ma ke s
Acu e changes in IL-6 om he p eope a i e le el o POD 1
inc eased wi h age (Figu e 1(a)). The le el o IL-6
inc eased in bo h g oups om he p eope a i e le el o i s
highes alue a POD 1 and he ea e s a ed o dec ease,
hough i was s ill ele a ed a POD 3. The inc ease was
highe in he olde age-g oup. Mean (95%CI) di e ence
be ween he age-g oups in changes o IL-6 a PODs 1 and 3
Figu e 1. (a) Mean IL-6 alues in lumba spinal usion su ge y pa ien s om p eope a i e o 6 weeks pos ope a i ely. Adjus ed o age,
leisu e- ime physical ac i i y, body a pe cen age, and smoking. Whiske s show 95% con idence in e als. Signi ican di e ences we e
ound be ween he age-g oups in changes o IL-6 a POD 1 (p¼0.014) and POD 3 (p¼0.021). (b) Rela ionships o acu e changes in IL-6
om p eope a i e o POD 1 as he unc ion o age. The cu es we e de i ed om 5-kno es ic ed cubic splines eg ession models.
The models we e adjus ed o leisu e- ime physical ac i i y, body a pe cen age, and smoking. G ay a ea ep esen s 95% con idence
in e als. IL-6: in e leukin-6; POD: pos ope a i e day.
Repo e al. 3
was 45 pg/ml (10 o 83, p¼0.014) and 20 pg/ml (5 o 36, p
¼0.021), espec i ely (Figu e 1(a)). A 6 weeks a e he
ope a ion, IL-6 le els we e a a no mal (equal o p eope a-
i e) le el in bo h g oups.
The e was an inc ease in hs-CRP om he p eope a i e
le el o POD 1 acco ding o age (Figu e 2(a)). The hs-CRP
le el s a ed o inc ease a POD 1 in bo h g oups and
achie ed i s highes alue on POD 3. Mean (95%CI) di -
e ence be ween g oups in changes o hs-CRP on PODs 1
and 3 we e 9.6 mg/l (3.5 o 22.7 mg/l, p¼0.47) and 24.8
mg/l (17 o 67 mg/l, p¼0.33), espec i ely. Thi een o
he 49 pa ien s had an hs-CRP le el o e 200 mg/l le el
measu ed a POD 3. Fu he mo e, 11 o hese pa ien s we e
o e 60 yea s. A 6 weeks, hs-CRP le els had dec eased o
he p eope a i e le el in bo h g oups (Figu e 2(b)).
The co ela ion was he s onges be ween he changes
om baseline o POD 1 in IL-6 and hs-CRP le els
( ¼0.65, 95%CI 0.46 o 0.85). The e was a mode a e
co ela ion be ween IL-6 change in POD 3 and hs-CRP
change in POD 3 ( ¼0.57, 95%CI 0.33 o 0.80),
be ween IL-6 change a POD 1 and hs-CRP change in
3days( ¼0.40, 95%CI 0.14 o 0.66). No co ela ion
was ound be ween he changes om baseline o POD 3
o IL-6and oPOD1 o hs-CRPle els( ¼0.16, 95%
CI 0.14 o 0.47).
The e was a s a is ically signi ican di e ence
(p¼0.043) in he POD 3 IL-6 alues pa ien s who had
unde gone one le el usion and hose who had unde gone a
leas wo le el usion. O he es ed in lamma ion ma ke s
in he p ede ine ime poin s we e non-signi ican .
Discussion
Spinal usion su ge y causes issue auma leading o an
acu e in lamma ion eac ion in all age-g oups. In he p es-
en s udy, he in lamma o y esponse was s onge in
pa ien s o e 60 yea s, al hough he du a ion o he su ge y
and blood loss we e compa able be ween he wo age-
g oups. To he au ho s’ knowledge, he p esen s udy was
he i s o in es iga e whe he he le els o in lamma o y
ma ke s a y be ween olde and younge pa ien s a e
ins umen ed lumba spine usion. P o-in lamma o y IL-6
and he acu e-phase p o ein CRP a e a p esen he key
componen s in he in lamma o y esponse. In spinal su -
ge y, CRP alues a e used o e alua e he healing p ocess
and he occu ence o pos ope a i e complica ions such as
in ec ion. In he p esen s udy, he peak alue o IL-6 was
highes a POD 1 and he hs-CRP was he highes a POD 3
a e he spinal usion p ocedu e, esul s which a e in line
wi h p e iously published da a.
9,10
This was p obably due
o he ac ha he p oduc ion o CRP is media ed by he
IL-6, a p ocess ha akes ime. O e all, he in lamma o y
esponse o olde pa ien s appea ed o show highe le els o
IL-6 and CRP p oduc ion.
The iming and quan i y o he IL-6 and hs-CRP peak
concen a ions depend on he ex en o damaged issue
11–15
Figu e 2. (a) Mean CRP alues in lumba spinal usion su ge y pa ien s om p eope a i e o 6 weeks pos ope a i ely. Adjus ed o age,
leisu e- ime physical ac i i y, body a pe cen age, and smoking. Whiske s show 95% con idence in e als. The e we e no signi ican
di e ences no ed be ween he age-g oups in changes o hs-CRP on PODs 1 (p¼0.47) and POD 3 (p¼0.33). (b) Rela ionships o acu e
changes in CRP om p eope a i e o POD 1 as he unc ion o he age. The cu es we e de i ed om 5-kno es ic ed cubic splines
eg ession models. The models we e adjus ed o leisu e- ime physical ac i i y, body a pe cen age, and smoking. G ay a ea ep esen s
95% con idence in e als. hs-CRP: high-sensi i i y C- eac i e p o ein; IL-6: in e leukin-6; POD: pos ope a i e day.
4Jou nal o O hopaedic Su ge y 27(1)

and he s eng h o he in lamma o y esponse.
4,19
In gen-
e al IL-6 and CRP le els a e highe a e open su ge y han
in minimally in asi e lumba spine usion.
11–15
Fu he -
mo e, he CRP and IL-6 alues a e ins umen ed spinal
usion a e highe han hose a e non-ins umen ed spinal
usion o decomp ession-only su ge y.
9,10
In he p esen
s udy, all pa ien s unde wen open ins umen ed su ge y
wi h midline app oach and de achmen and e ac ion o
ex enso muscles, which esul s in high IL-6 and CRP le -
els. In addi ion, he e we e 11 pa ien s o e 60 yea s on
whom mo e han wo le el usions we e pe o med. These
addi ional le els o usion ins umen a ion could pa ly
explain he s onge in lamma o y esponse.
In he p esen s udy, changes in se um concen a ions o
CRP adhe ed o he IL-6 le els. CRP le els inc ease du ing
he i s h ee PODs in pa ien s who ha e unde gone spinal
su ge y.
8,9
In e es ingly, s a is ical signi icance was ound
be ween he wo age g oups in he IL-6 le els bu no in he
CRP le els. The absence o a apid decline o seconda y
ise in CRP le els a e he acu e phase indica es pos ope a-
i e in ec ion.
10,16–18
Se um IL-6 concen a ion inc eases
apidly wi hin 1 day a e spinal su ge y and dec eases
wi hin a week o he p eope a i e le el.
8
Thelande and
La sson epo ed ha CRP alue eached i s peak on POD
3 and dec eased o a no mal le el o e 14 days a e ins u-
men ed pos e io lumba in e body usion in pa ien s wi h
uncomplica ed su ge y.
12
IL-6 media es he p oduc ion o
CRP. This p ocess can ake ime. Aono e al. epo ed ha
19 o he 143 pa ien s who had unde gone pos e io lumba
in e body usion in ea men o degene a i e spinal disease
had a CRP le el o 100 mg/l on POD 4.
18
In he p esen
da a, no pos ope a i e in ec ions we e obse ed. A he
6-week ollow-up, he hs-CRP alues o all pa ien s had
dec eased back o he p eope a i e le el.
A p ope in lamma o y eac ion is essen ial o issue
healing and in ec ion con ol a e su ge y.
24
Howe e ,
imbalance be ween p o- and an i-in lamma o y media o s
inc eases he isk o pos ope a i e in ec ion.
25
In addi ion
o weake p eope a i e physical condi ion, he s onge
in lamma o y esponse is one eason o slowe unc ional
eco e y.
26
Aging is also connec ed wi h ch onic low-g ade
in lamma ion.
27
Fu he mo e, isce al a and in e muscu-
la high a has been shown o inc ease IL-6 and CRP
concen a ions.
28
The p esen s udy showed ha in addi ion
o ch onic in lamma ion, olde pa ien s had s onge acu e
in lamma o y eac ion a e lumba spine usion. The IL-6
concen a ion inc eased om he p eope a i e le el o POD
1 along wi h he age o he pa ien . The same endency was
no ed in he hs-CRP concen a ions du ing PODs 1–3. Mus-
cle mass dec eases in he aging p ocess. Thus, hypo he i-
cally, auma caused by issue s e ching in he ope a ion
should also dec ease. I seems ha , in addi ion o he ex en
o he issue auma, sensi i i y o su gical auma, blood
loss, and pe iope a i e s ess migh cause a s onge
in lamma o y esponse in olde pa ien s who unde go
ins umen ed spinal usion. In he p esen s udy, he
s onges co ela ion in in lamma o y ma ke s was in he
changes om baseline o POD 1 in IL-6 and hs-CRP le els.
An unexpe ienced physician may conside he ise o
CRP le els as an indica ion o in ec ion. To he au ho s’
clinical expe ience, when he CRP alues ha e isen abo e
150, an unnecessa y an ibio ic ea men may ha e had
ini ia ed du ing he pos ope a i e eco e y phase a e lum-
ba spine usion su ge y. CRP alues each hei ip on he
POD 3 acco ding o he epo by Thelande and La sson.
12
The p esen s udy showed ha he dec ease in he IL-6
alue was al eady no iceable on he POD 3 a e decom-
p ession and lumba spine usion. Conside ing hese ind-
ings, he ise o he CRP alues should con inue a e POD
3 o indica e an unde lying in ec ion. The diagnos ics o an
in ec ion migh be pos poned as CRP should be measu ed
epea edly. Based on he esul s p esen ed he e, ise in he
IL-6 le el on POD 4 would indica e in ec ion. Measu ing
bo h he IL-6 and he CRP could gi e insigh o absence o
p esence o in ec ion.
One o he s eng hs o his s udy was i s p ospec i e
se ing, which allowed IL-6 and hs-CRP measu emen s a
dis inc ime poin s. Fu he , he s udy assessed p o-
in lamma o y cy okine and acu e phase p o ein as aw
labo a o y alues o b ing deepe insigh o he in lamma-
ion esponse a e ins umen ed lumba spine usion. The
s udy used a comp ehensi e ques ionnai e compila ion o
assess pa ien s’ baseline heal h s a e. One could specula e
ha pa ien s’ isce al o body a pe cen age could ha e
been assessed o elimina e bias. Howe e , his was no he
scope o he s udy, and he wo g oups we e compa able in
BMI alues. The iming o aking he blood samples was
based on no mal clinical p ac ices jus be o e hospi al dis-
cha ge, and a 6-week and 3-mon h ollow-ups. The blood
samples we e ob ained, o e hical as well as p ac ical ea-
sons, in eal clinical se ings o gua an ee ha pa ien s
would be incon enienced as li le as possible. The iming
was simila as in p e iously published s udies,
9–18
hough
his s udy had a signi ican ly longe ollow-up o he inal
blood sample han did s udies wi h a simila scope. Th ee o
he 52 pa ien s had o be excluded om he analyses as
blood samples we e no ob ained a e e y ime poin o
pa ien s had al eady ea en hei b eak as . The esul s a e
gene alizable o pa ien s who ha e unde gone ins umen ed
lumba spine usion and decomp ession. None heless,
pa ien s’ gene al condi ion,
29
leng h o he usion a ea, o
in asi eness o he su ge y migh ha e an impac o he
pos ope a i e CRP alues. As hese ac o s we e no spe-
ci ically in es iga ed in his s udy, u u e s udies could
add ess his pa icula ques ion.
Conclusions
The inc ease in IL-6 and hs-CRP concen a ions a e he
su ge y is s onge in pa ien s o e 60 yea s o age. The
IL-6 and hs-CRP p o ed o be sensi i e ma ke s o acu e
pos ope a i e in lamma ion. Thei concen a ions e u ned
Repo e al. 5
o no mal le el 6 weeks a e lumba spine usion in
pa ien s wi hou pos ope a i e in ec ion. E en high CRP
alues do no necessa ily indica e pos ope a i e in ec ion.
Decla a ion o con lic ing in e es s
The au ho (s) decla ed no po en ial con lic s o in e es wi h
espec o he esea ch, au ho ship, and/o publica ion o
his a icle.
Funding
The au ho (s) disclosed eceip o he ollowing inancial suppo
o he esea ch, au ho ship, and/o publica ion o his a icle: The
s udy is unded by he Compe i i e S a e Financing o he Expe
Responsibili y A ea o Tampe e Uni e si y Hospi al.
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6Jou nal o O hopaedic Su ge y 27(1)