Intrawound Vancomycin powder as the prophylaxis of surgical site infection after invasive spine surgery with a high risk of infection

Surgical site infections (SSIs) are one of the most serious complications in spine surgery. We investigated the efficacy of locally administered vancomycin (VCM) powder for prophylaxis on SSI after invasive spine surgery. We retrospectively studied 174 consecutive patients who underwent spine surgery. In patients of the VCM group (n = 81), VCM powder was administered in the wound before closing wound. Patients who did not receive VCM treatment were set as a control group (n = 93). We compared the patients' background, operation time, intraoperative blood loss, usage of implants, presence of deep SSI, and side effects between the two groups. There were no significant differences between the groups in age, gender, and BMI. The operation time and the intraoperative blood loss were longer and greater in the VCM group than in the control group (P < 0.005, P < 0.001, respectively). Implants were used in 85% of the VCM group, and in 31% of the control group (P < 0.001). Deep SSI was not observed in the VCM group, whereas it was observed in 4 patients in the control group. No side effects were observed in any of the cases. In conclusion, surgeons applied VCM for cases which were invasive or had a high risk of infection. However, deep SSI was not observed in anyone in the VCM group. The intrawound administration of VCM might be effective to prevent SSI in cases with high risks of infection.