Vancomycin Powder in Spine Surgery: Still a Work in Progress

Abstract

Surgical site infections (SSIs) after complex spinal surgery are associated with significant neurological morbidity and mortality and can lead to increased medical costs. Reasons for the development of these types of infection can be multifactorial. Those risk factors that are patient related include advanced age, diabetes mellitus, smoking, malnutrition, drug abuse, alcoholism, increased body mass index, and immunosuppression. All of these factors will decrease a patient’s ability to mount an adequate immune response that will prevent the development of an infection. Microvascular injury resulting in tissue ischemia contributes to the risk of SSI in diabetes mellitus and in smokers. Smoking cessation, strict blood glucose control, and an optimized nutritional state can diminish the potential for postoperative SSI. SSIs have been classified into superficial or deep depending on the location in which the infection occurs. Involvement of the skin and subcutaneous tissue defines a superficial infection in contrast to a deep SSI where the fascial and muscle layers are involved. It has been estimated that the rate of deep SSI in lumbar spinal instrumentation surgery ranges from 1%e14% (3). Specific prognostic variables that are associated with an increased risk of postoperative SSI are repeat/revision surgery, type of surgery (i.e., deformity correction vs. fusion procedure), longer operative time, intraoperative blood loss, blood transfusion, number of spinal levels fused, posterior surgical approach, pelvic instrumentation, and the number of personnel in the operating room (3). The use of drains postoperatively has not been shown to reduce SSIs and may in fact lead to the development of SSIs with prolonged usage.