Methods to Decrease Postoperative Infections Following Posterior Cervical Spine Surgery

Abstract

In this study, preliminary preparation with alcohol foam and the placement of suprafascial drains for deep wounds resulted in one postoperative deep infection in 323 surgical procedures. The addition of intrawound vancomycin powder in 195 consecutive posterior cervical spine surgical procedures resulted in no infections and no adverse effects. To our knowledge, this is the first description of a technique for significantly decreasing postoperative cervical spine infections.

Experience with intrawound vancomycin powder for posterior cervical fusion surgery

“…Cohort studies showed that vancomycin powder significantly reduced postoperative SSIs in adult thoracolumbar fusion surgery (n = 165-1732, 2.6%-12% vs 0%-0.2%, p < 0.001), 21,22 posterior fusion after traumatic etiologies (n = 110, 13% vs 0%, p = 0.02), 15 and posterior cervical decompression and fusion surgeries (n = 171-576, 1.73%-15% vs 0%-2.5%, p < 0.05). 2,17,20 Similarly, after introduction of vancomycin powder, Molinari et al reported a low (1.20%) SSI rate in spine fusion surgery (n = 663), 14 and Gans et al reported a low (3.4%) SSI rate in pediatric spine deformity fusion cas- es (n = 87). 3 In a cost analysis, Godil et al postulated that decreased SSI rates due to vancomycin powder can lead to a potential cost savings of $438,165 per 100 patients.…”

“…Most initial studies have supported adjunctive powdered vancomycin, reporting decreased rates of postoperative wound infection and no adverse side effects. 2,3,14,15,17,[20][21][22]24 Local vancomycin has long been tested in sternotomy wounds following cardiac surgery. In a 1989 blinded, randomized study involving 416 patients, Vander Salm et al reported a significant reduction of sternal infections (3.6% vs 0.45%, p = 0.02) with topical vancomycin applied to the cut edges of the sternum.…”

“…1,6,7 Given the incidence of deep wound infections, several authors explored and subsequently published their results on locally applied prophylactic vancomycin antibiotic powder, in addition to systemic antibiotics, to reduce postoperative spinal SSIs. [2][3][4]9,[13][14][15][16][17][20][21][22]24 Perioperative vancomycin powder is an attractive option for additional prophylaxis against postoperative SSI due to its low cost and broad coverage. Numerous studies have shown that the addition of local vancomycin aBBreviatiONS BMI = body mass index; CDC = Centers for Disease Control and Prevention; COPD = chronic obstructive pulmonary disease; CTJ = cervicothoracic junction; EBL = estimated blood loss; MRSA = methicillin-resistant Staphylococcus aureus; SSI = surgical site infection.…”

“…2,[17][18][19][20]27 Compared with lumbar surgeries, Gruskay et al showed that cervical fusion cases were associated with a significantly lower rate of infection (n = 5023, 4.3% vs 2.75%, p = 0.003), with posterior cervical fusion cases having a significantly higher rate of infection than anterior cervical cases (n = 2544, 6.0% vs 0.4%, p < 0.001). 5 Postoperative infections have a deleterious impact on patients, as they often require more hospitalizations, surgical procedures, and resultant increased economic burden.…”

“…2,4,14,15,17,[20][21][22] A few cohort studies have looked at posterior cervical fusion cases and have reported significant reductions in the incidence of postoperative deep SSI rates from 10.9%-15.0% to 0%-2.5% after the introduction of perioperative vancomycin powder. 2,17,20 However, these studies were limited by small cohort patient sizes, with fewer than 172 total patients, and high control (nonvancomycin) postoperative SSI rates. Furthermore, a recent study published by Mariappan et al 11 highlighted the adverse systemic effects of locally applied vancomycin powder and questioned its effectiveness in reducing the incidence of postoperative spinal SSIs.…”