Use of Vancomycin Mixed Bone Graft and Vancomycin Mixed Saline Wash Before Wound Closure Reduces the Rate of Infection in Lumbar Spine Fusion Surgery.

Bikram Kar,Harshal Sakale,Sandeep Kumar Yadav,Nagaraju Venishetty

doi:10.7759/cureus.17275

Abstract

This study aims to evaluate whether surgical site vancomycin mixed in bone grafts and local vancomycin mixed in normal saline wash before wound closure decrease the infection rates in patients undergoing lumbar spinal instrumentation and posterolateral fusion. A retrospective study was performed on cases between 2017 and 2019, who underwent lumbar spine instrumentation and posterolateral fusion for lumbar canal stenosis or listhesis. The routine prophylactic procedures were performed in all patients as per institutional protocol. Patients' records were analysed and categorised into two groups, the vancomycin group (VG), where vancomycin mixed in bone graft and normal saline wash was used at the surgical site, and the control group (CG), where vancomycin was not used. The study included 63 patients, 31 in VG and 32 in CG. There is no statistical difference in age, sex, and diabetes mellitus in both groups. A total of seven cases were infected, six in CG (6/32) and one in VG (1/31). Out of six infections in CG, three patients had diabetes and four infected cases underwent surgery for debridement. In VG, the only single case got infected and treated with intravenous antibiotics. We found that the use of vancomycin added to the bone graft and normal saline in posterior lumbar spinal instrumentation and posterolateral fusion is associated with significantly lower rates of infection (p value=0.049).

Highlights

Infection after spinal surgery with instrumentation is a devastating complication that increases patient morbidity, mortality, and treatment costs as multiple surgeries and specific antibiotics are used [1]
Decompression or fusion, without instrumentation, postoperative surgical site infection rates range from 0.7% to 2.3% and instrumentation in spinal surgeries increases this rate from 0.3% to 20% [2,5,6]
Posterior lumbar spinal instrumentation and posterolateral fusion were done with a local bone graft

Summary

Introduction

Infection after spinal surgery with instrumentation is a devastating complication that increases patient morbidity, mortality, and treatment costs as multiple surgeries and specific antibiotics are used [1]. Obesity, poor nutrition, prolonged surgical time, increased blood loss, smoking, implants, and revision surgery are few among them [2] The rates of these postoperative infections after spinal surgeries have to be documented accurately as it helps to improve the quality of treatment, proper patient counselling, and surgical decision making. In their study, concluded that the use of vancomycin powder placed in the wound before wound closure had shown a low rate of deep spinal wound infection in both instrumented and uninstrumented cases [2] In another study, both the use of antibiotics and antiseptic intrawound prophylactics reduced deep surgical site infections in instrumented spine surgery significantly by three to seven times, without any adverse reactions [17]

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