Does local vancomycin powder impregnated with autogenous bone graft and bone substitute decrease the risk of deep surgical site infection in degenerative lumbar spine fusion surgery?-An ambispective study

• Published in: BMC musculoskeletal disorders Vol. 23; no. 1; pp. 853 - 9
• Main Authors: Chou, Po-Hsin, Lin, Hsi-Hsien, Yao, Yu-Cheng, Chang, Ming-Chau, Liu, Chien-Lin, Wang, Shih-Tien
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.09.2022; BioMed Central; BMC
• Subjects: Antibiotics; Antimicrobial agents; Architects; Artificial bones; Back surgery; Biopsy; Bone biomaterials; Bone grafts; Bone Substitutes - therapeutic use; Bone surgery; Complications and side effects; Deep surgical site infection; Degenerative disc disease; Degenerative lumbar fusion surgery; Dosage and administration; Humans; Laboratories; Local delivery system; Musculoskeletal diseases; National health insurance; Orthopedics; Patient outcomes; Patients; Powder; Powders; Prevention; Prospective Studies; Retrospective Studies; Risk factors; Skin & tissue grafts; Spinal fusion; Spine (lumbar); Surgical drains; Surgical site infections; Surgical Wound Infection - drug therapy; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Surgical wound infections; Vancomycin; Vancomycin - adverse effects; Wound drainage; Taiwan; United States > US; Germany; Degenerative lumbar fusion surgery; Local delivery system; Vancomycin; Deep surgical site infection
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-022-05802-y

Deep surgical site infection (DSSI) is one of the most challenging complications in lumbar fusion surgery. Few investigations examined the effect of vancomycin powder mixed with autogenic bone graft (ABG) and bone substitutes on preventing DSSI in degenerative lumbar fusion surgeries as well as any interference with bony fusion. The aim of the study was to investigate the effects of ABG along with bone substitutes as a local vancomycin delivery system on preventing DSSI in lumbar instrumented fusion and compared with those who did not use vancomycin powder. From January, 2015 through December, 2015, a one-year prospective study using vancomycin powder mixed with ABG and bone substitute for degenerative lumbar fusion surgeries as vancomycin (V) group, 1 gm vancomycin for 2 and 3-level, and 2 gm for more than 3-level instrumentation. From December, 2013 through December 2014, patients received degenerative lumbar fusion surgeries without using vancomycin before the vancomycin protocol were retrospectively enrolled as non-vancomycin (NV) group. Vancomycin concentration was checked at post-operative days 1 and 3 for both the serum and drainage. Patients' demographic data, microbiology reports, fusion status and functional outcomes were evaluated. One hundred and ten patients were enrolled prospectively in the V group, and 86 for the NV group. After an average 41 months follow-up (range, 36-54), 3 patients (3.48%) developed postoperative DSSIs in the NV group, thereby requiring revision surgeries and parenteral antibiotics treatment versus no DSSIs (0%, 0/100) in the V group. (p = 0.048). The postoperative serum vancomycin levels were undetectable and no vancomycin related side effects was encountered. The mean vancomycin concentration of drainage at postoperative days 1 and 3 were 517.96 ± 174.4 and 220.14 ± 102.3 μg/mL, respectively. At final follow-up, there was no statistical difference observed in terms of clinical and radiologic outcomes. Our vancomycin protocol may reduce the incidence of DSSI in degenerative lumbar fusion surgery without affecting bony fusion. Level III ambispective comparative study.