• Russell G Strom, Donato Pacione, Stephen P Kalhorn, and Anthony K Frempong-Boadu.
• *Department of Neurosurgery, NYU Langone Medical Center, New York, NY; and †Department of Neurosciences, Division of Neurosurgery, Medical University of South Carolina, Charlestown, SC.
• Spine. 2013 May 20;38(12):991-4.

Study DesignA retrospective cohort study.ObjectiveTo assess the ability of local vancomycin powder to prevent wound infection after posterior cervical fusion.Summary Of Background DataWound infections are a significant source of morbidity and cost associated with spine surgery. Intraoperative application of vancomycin powder to the wound edges has been shown to lower the infection risk after posterior instrumented thoracolumbar fusion. There is little data on the efficacy and safety of local vancomycin powder in cervical spine surgery.MethodsAll cases of posterior cervical fusion by a single surgeon were reviewed from 2007 to 2011. Routine application of 1 gram of vancomycin powder was started in August 2009. Baseline characteristics, operative details, and rates of wound infection and pseudarthrosis were compared between untreated patients and those who received vancomycin powder.ResultsA total 171 patients underwent posterior cervical fusion between 2007 and 2011. Baseline and operative variables were similar between untreated patients (n = 92) and those who received vancomycin powder (n = 79). Patients were followed for a minimum of 1 year (range, 1.1-5.7 yr). The infection rate fell from 10.9% to 2.5% (P = 0.0384) following the introduction of vancomycin powder. The untreated and treated groups had similar rates of pseudarthrosis (5.4% vs. 5.1%). No complications attributable to vancomycin powder were identified.ConclusionRoutine local application of vancomycin powder is a low-cost effective strategy for preventing wound infection after posterior cervical fusion. Further studies are needed to optimize dosing, assess long-term safety, and evaluate use in other spinal operations.Level Of Evidence2.

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