Abstract

Aim:To determine the effect of local application of vancomycin powder on surgical site
infection rate in patients undergoing instrumented spinal fusion surgeries.
Methodolgy:This is a prospective, cohort study which was conducted at SVIMS, a tertiary care
hospital. Informed consent was obtained from all the patients recruited in the study. The study
conducted during July 2015 to July 2016 with follow up of patients for 1 year post
operatively.The study cohort included consecutive patients undergoing posterior spinal fusion for
various etiologies. All patients received standard systemic antibiotic prophylaxis consisting of 1
g IV ceftriaxone within 1 hour of surgical incision followed by 1 g IV ceftriaxone every 8 hours
for 1 day. All patients underwent preoperative preparation with betadine solution.
Results:Total of 120 patients who underwent instrumented spinal fusion procedures were
included in the study with or without topical application of vancomycin powder.Mean age of
presentation in test group was 38.3 yrs whereas in control group it is 45.2 yrs.Most of the
patients who underwent operation for listhesis in the present study were females with F:M ratio
being 3.6:1.Only 4 of the patients from test group and 3 patients from control group gave history
of smoking and alcoholism. SSI developed in only one of the patients with both smoking and
alcoholism as risk factors.8 patients from test group and 9 patients from control group had
comorbidities like diabetes, hypertension, rheumatoid arthritis, hepatitis B.None of the patients
in the present study gave history of previous lumbar surgeryMost of the patients presented with
symptoms of low back ache and the most common neurological deficit encountered was motor
weakness related to respective spinal segment. In the test group 53 single level fusions and 7 two
level fusions were done whereas in control group 55 single level fusions, 3 two level fusions and
2 three level fusions were done .Mean operative time in test group was 239.6 mts and mean
estimated blood loss was 87.4 ml whereas in control group it is 221.25 mts and 88.08 ml
respectively.Two patients in the test group had deep SSI of which one required implant removal
on readmission and the other patient was managed conservatively when he was diagnosed to
have spondylodiscitis post operatively with appropriate antibiotics.