Serum CPK and LDH after anterior approaches to the thoracic and lumbar spine
Wukich-DK; Van-Dam-BE; Graeber-GM; Martyak-T Spine. 1990 Mar; 15(3): 187-90 AB: Ten patients undergoing anterior approaches to the thoracic and lumbar spine had prospective determinations of serum creatine kinase, lactate dehydrogenase, and their myocardial-associated isoenzymes (CK-MB and the LD-1/LD-2 ratio). None of these patients experienced postoperative myocardial infarction. Skeletal muscle injury associated with anterior spinal surgery resulted in significant elevations of serum CK-MB on postoperative Day 1; however, the LD-1/LD-2 ratio did not change significantly. Although false-positive elevations of serum CK-MB occurred, no patient had a CK-MB value exceeding 50 IU/liter combined with an LD-1/LD-2 ratio exceeding 1.0 (so-called "flipped LD" pattern). In evaluating suspected postoperative myocardial infarction, the authors recommend determining the isoenzymes of both serum creatine kinase and lactate dehydrogenase. In postoperative patients, elevations of CK-MB exceeding 50 IU/liter combined with an LD-1/LD-2 ratio exceeding 1.0 should not be attributed to skeletal muscle injury alone after anterior approaches to the thoracic and lumbar spine.
Original Text by Clifford R. Wheeless, III, MD.
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