New inflammation markers for early detection of spondylodiscitis.

Even today a significant feature of spondylodiscitis is the long interval between the onset of symptoms and the establishment of the diagnosis (on average 6.4 months in our study). In order to improve early detection of spinal infections, new markers of inflammation were determined in patients with spondylodiscitis. Neopterin is produced by macrophages after their activation by T-lymphocytes, polymorphonuclear neutrophil (PMN) elastase is set free by activated granulocytes. Erythrocyte sediment rate (ESR) showed the highest sensitivity of all determined inflammation markers, but reached only a poor diagnostic specificity. The sensitivity of the white blood cell count was poor. C-reactive protein (CRP) and neopterin reached a sensitivity of 75% each in spondylodiscitis and had a good diagnostic specifity. Sensitivity of PMN elastase reached 67%. Contrary to ESR the new inflammation markers were also helpful in the following up of treated spondylodiscitis. PMN elastase showed quickest normalization of all inflammation parameters. For early detection of spondylodiscitis and clinical follow up we recommed combined determinations of CRP, neopterin and PMN elastase.