Effect of intrasite vancomycin powder on development of epidural fibrosis

Abstract

Placement of vancomycin powder into the surgical wound prior to closure has been shown to reduce postoperative infections in spine surgery. This study examines the effect of vancomycin powder on formation of epidural fibrosis (EF). Twenty-two rats underwent a two-level lumbar laminectomy. A control group, a low-dose and a high dose vancomycin powder (applied prior to closure) group was formed. Rats were sacrificed at 30 days and a blinded fellowshiptrained pathologist evaluated the laminectomy segments for EF. 50% of the samples in the high-dose vancomycin group were EF grade 3, compared to 20% of the low-dose and 16.7% of control samples. The average fibrosis grade for the high dose, low dose and control groups were 2.4, 1.4 and 1.8, respectively. There were more grade 3 EF specimens in the high dose vancomycin group. While the average EF grade was also higher in this group, there was not a statistical difference compared with the other groups.

Periferik sinir üzerinde topikal uygulanan vancomisin toz perinöral fibrozise neden olur mu?

“…Therefore, local and prophylactical use of vancomycin has become widespread rapidly. The studies investigating the side effects of vancomycin powder have questioned new bone formation, hypersensitivity reactions and epidural fibrosis [5,11]. Although peripheral nerve surgery and spine surgery are generally examined under the same heading, most of the local vancomycin powder studies in the literature have been conducted in the spine surgery area, and there are no studies on peripheral nerves [6,10,14,15,18].…”

“…However, the presence of grade 2 epidural fibrosis in group 2, even in only one experimental animal, suggests that a dose-dependent effect may be observed. Clippinger et al [5] applied vancomycin powder locally to rats following laminectomy and investigated the development of epidural fibrosis in their experimental study. Although no statistically significant difference was found between the control group and animals with vancomycin powder administered, it was emphasized that the result might be different in a study group with more rats.…”

“…It has been reported in the literature that the incidence in different series is between 0.7% and 12.0% [1][2][3]. SSI has been reported to increase healthcare cost, readmissions rate, and length of hospital stay [4][5][6]. To avoid these unfavorable situations, preventive strategies are being developed.…”

“…There is only one study in the literature investigating the effect of vancomycin powder on epidural fibrosis. This study was performed on rats undergoing laminectomy [5]. To the best of our knowledge, the first study conducted on peripheric nerves in the literature is our study.…”

Is Use of Topical Vancomycin in Pediatric Spine Surgeries a Safe Option in the Prevention of Surgical Site Infections? A Meta-analysis and Systematic Review of the Literature

“…Thus, TVP affects dural healing after intentional or unintentional durotomy in spinal surgery. Clippinger et al 33 also studied the effect of TVP on dura in rat models. They observed a higher grade of epidural fibrosis 30 days after the application of high-dose TVP when compared with the low-dose and control groups.…”