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

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).

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

“…There have been many articles on the topical of local vancomycin to reduce the risk of infection after orthopaedic surgery [3,38,39]. Moreover, vancomycin impregnated bone graft has been also widely used in spinal surgery [40][41][42]. Therefore, a prospective randomized study with an adequate patient number is needed to clarify the benefits of vancomycin impregnated autogenous bone graft and bone substitute on preventing DSSI following degenerative lumbar spine fusion surgery.…”

Synthesis and evaluation of a novel vancomycin-infused, biomimetic bone graft using a rat model of spinal implant-associated infection

“…However, this study also reported significantly reduced arthrodesis in the vancomycin-loaded cohort and proposed the utility of vancomycin-loaded demineralized bone matrix as an extension of iliac bone crest autograft [17] . Multiple retrospective clinical studies of infection in spinal fusion surgery have also demonstrated the effectiveness of vancomycin impregnation in autologous bone grafts to prevent infection [ 31 , 32 ]. However, the use of antibiotic-loaded bone grafts is currently not standard in spinal or orthopedic applications due to the possible impairment of osteoblast differentiation [ 33 , 34 ].…”