The Role of Vancomycin Powder During Spinal Cord Stimulator Implantation: A Case Series and Review of the Literature

World Neurosurg. 2021 Sep 6:S1878-8750(21)01329-2. doi: 10.1016/j.wneu.2021.08.141. Online ahead of print.


OBJECTIVE: To examine the role of intrawound vancomycin powder as prophylaxis against postoperative surgical site infection (SSI) following spinal cord stimulator (SCS) implantation.

METHODS: We performed a retrospective analysis of 153 consecutive patients who underwent permanent SCS implantation surgery via open laminectomy between 2014 and 2020. We queried each medical record for patient age, sex, relevant medical history, and whether intrawound vancomycin was administered. We compared rates of SSI (primary outcome) and seroma (secondary outcome) within three months of surgery between the vancomycin and non-vancomycin groups. Lastly, we conducted multivariable logistic regression analyses to identify independent predictors of postoperative SSI or seroma.

RESULTS: The cohort (n=153) was 59% female and had an average age of 65.4 years. Overall, three patients (2%) developed an SSI: two (MRSA, Klebsiella) in the vancomycin group and one (MSSA) in the non-vancomycin group. This difference in SSI rate between groups was insignificant (P=.73). Three seromas, all in the non-vancomycin group, accounted for a statistically significant difference in seroma formation between the groups (P=.04). Multivariate logistic regression failed to identify any perioperative characteristics as independent predictors of postoperative SSI or seroma.

CONCLUSIONS: Our experience suggests open laminectomy for SCS implantation surgery can be performed with a low postoperative SSI rate, with or without powdered vancomycin. We found no evidence suggesting powdered vancomycin is unsafe - or related to postoperative seroma formation - and failed to draw any definitive conclusion as to its efficacy, despite referencing the largest single case series of spinal cord stimulation implantation to date.

PMID:34500098 | DOI:10.1016/j.wneu.2021.08.141