Both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are highly sensitive (84-100%) for spinal infections and are observed in >80% with vertebral osteomyelitis and epidural abscesses.
ESR
Most sensitive and specific serum marker, usually elevated in both spinal epidural abscess (SEA) and vertebral osteomyelitis.
ESR was elevated in 94-100% of patients with SEA vs. only 33% of non-SEA patients
Mean ESR in patients with SEA was significantly elevated (51-77mm/hour)
CRP
Not highly specific
Less useful for acute diagnosis since CRP levels rise faster and return to baseline faster than ESR (elevated CRP seen in 87% of patients with SEA as well as in 50% of patients with spine pain not due to a SEA)
Better used as a marker of response to treatment.
References
1) Colip CG, Lotfi M, Buch K, Holalkere N, Setty BN. Emergent spinal MRI in IVDU patients presenting with back pain: do we need an MRI in every case? Emerg Radiol 2018;25:247-56.
2) Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine 2011;14:765-70.
