Monitoring creatine kinase in spine surgery and its relation to acute renal failure

ABSTRACT

Serum creatine kinase [CK] is the gold standard marker for muscle injury. Any muscle damage, if severe enough, can lead to rhabdomyolysis [RM] and subsequent renal failure if not treated properly. This is usually correlated with high levels of creatine kinase. Spine interventions in orthopaedic surgery are associated with surgical "injury" to the back muscles and abnormal levels of creatine kinase. Rhabdomyolysis associated with spine surgery is in fact multifactorial, and most commonly due to prolonged surgery time and certain operative positions, correlated with high risk of developing compartment syndrome [CS]. However, the final complication of acute renal failure is exceptional in these procedures. This paper reviews all reported cases of rhabdomyolysis and acute renal failure following spinal interventions, and discusses the role of creatine kinase in the evaluation of muscle injury as a predictor of rhabdomyolysis and acute renal failure. Most spine surgeries are in fact not correlated with rhabdomyolysis and acute renal failure as this correlates with very high levels of creatine kinase. As a result, monitoring creatine kinase is only advised to follow in certain circumstances, and will only lead to unnecessary expenses