Table 1.
Summary of infection rates and methodology of studies of instrumented spinal procedure.
| Authors/year | Study design/method of controlling for bias | No. of pts | Age range of pts | Included spinal diagnoses/procedures | Intervention | Wound infection rates in treatment group | Wound infection rates in control group |
|---|---|---|---|---|---|---|---|
| Adhikari et al. 2020 [20]‡ | RC/NR | 141 | Adults | Deformity, degenerative, trauma, neoplastic/posterior instrumented fusion | Vancomycin powder 1 g | 3.53% (3/85) | 1.79% (1/56) |
|
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| Caroom et al. 2013 [21]∗ | RC/NR | 112 | NR | Cervical spondylotic myelopathy/posterior instrumented fusion | Vancomycin powder 1 g | 0% (0/40) | 15.28% (11/72) |
|
| |||||||
| Dewan et al. 2013 [22]a,∗ | RC/NR | 455 | NR | Degenerative/posterior spinal fusion | Vancomycin powder 1 g | 0% (0/137) | 5.66% (18/318) |
|
| |||||||
| Ehlers et al. 2016 [23]b | PC/propensity score matching | 6910 | NR | Instrumented cervical or lumbar fusion | Intrawound antibiotics (type and dose NR) | 0.93% (32/3455) | 1.30% (45/3455) |
|
| |||||||
| Emohare et al. 2014 [24]c | RC/multivariate analysis, pseudo-randomization by surgeond | 200 | NR | Degenerative/posterior instrumented thoracic, thoracolumbar, lumbar fusion | Vancomycin powder 1 g | 0% (0/78) | 3.28% (4/122) |
|
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| Gaviola et al. 2016 [25] | RC/multivariate analysis | 326 | 40–71 | Instrumented multilevel fusion | Vancomycin powder 2 g | 5.17% (6/116) | 11.0% (23/210) |
|
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| Haimoto et al. 2018 [26]∗ | RC/NR | 515 | 18 and above | Posterior instrumented cervical, thoracic, lumbar fusion | Vancomycin powder 1 g | 0% (0/247) | 5.60% (15/268) |
|
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| Heller et al. 2015 [27]‡ | RC/NR | 683 | NR | Degenerative, deformity, neoplastic, others/posterior instrumented fusion | Vancomycin powder 0.5–2 g | 2.63% (9/342) | 5.28% (18/341) |
|
| |||||||
| Hey et al. 2017 [28]∗ | RC/multivariate analysis, pseudo-randomization | 389 | 11–85 | Degenerative, trauma, neoplastic/open instrumentation | Vancomycin powder 1 g | 0.85% (1/117, 1 deep) | 6.25% (17/272, 10 deep, 7 superficial) |
|
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| Horii et al. 2018 [29]b | RC/propensity score matching | 1014 | 15 and above | Degenerative, deformity, trauma, neoplastics/posterior instrumentation | Vancomycin powder 1–2 g | 1.58% (8/507) | 1.78% (9/507) |
|
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| Kim et al. 2013 [30]∗ | RC/logistic regression, multivariate analysis, and cox regression | 74 | NR | Spinal instability/posterior instrumented fusion | Vancomycin powder 1 g | 0% (0/34) | 12.5% (5/40, 3 deep, 2 superficial) |
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| Kunakornsawat et al. 2019 [31]‡ | RCT/randomizations | 400 | 11–82 | Trauma, degenerative, congenital, neoplastic, infectious/posterior instrumented thoracic or lumbosacral fusions | Vancomycin powder 1–2 g | 3.40% (9/265) | 2.96% (4/135) |
|
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| Lemans et al. 2017 [32]∗ | RC/NR | 505 | Adults | Open posterior instrumentation | Vancomycin powder 1–2 g | 4.44% (8/180, 5 deep, 3 superficial) | 13.85% (45/325, 31 deep, 14 superficial) |
|
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| Liu et al. 2015 [33]‡ | RC/NR | 334 | 53.5–74 | Deformity, degenerative, neoplastic/posterior instrumentation | Vancomycin powder 0.5–2 g | 2.78% (5/180) | 7.14% (11/154) |
|
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| Ludwig do nascimento et al. 2020 [34] | RCT/randomization, double blinding | 96 | 17–74 | Degenerative, trauma/thoracolumbar spine arthrodesis | 20 ml of saline with 2 g of diluted vancomycin | 8.16% (4/49) | 8.51% (4/47) |
|
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| Martin et al. 2014 [35]b,‡ | RC/logistic regression, propensity score matching | 306 | 18 and above | Deformity/posterior instrumented fusion | Vancomycin powder 2 g | 5.12% (8/156) | 5.33% (8/150) |
| Ogihara et al. 2021 [36]‡ | RC/multivariable analysis | 2913 | 18–93 | Degenerative/posterior instrumented fusion in the thoracic/lumbar spines | Vancomycin powder | 1.52% (7/460) | 1.14% (28/2453) |
|
| |||||||
| Oktay et al. 2020 [37]∗ | RC/NR | 209 | 14–90 | Degenerative, trauma, neoplastic, revision/posterior instrumentation | Vancomycin powder 1 g | 1.96% (2/102, 1 deep, 1 superficial) | 6.54% (7/107, 4 deep, 3 superficial) |
|
| |||||||
| O'Neill et al. 2011 [38]∗ | RC/pseudo-randomization | 110 | 18 and above | Trauma/posterior instrumented fusion | Vancomycin powder 1 g | 0% (0/56) | 12.96% (7/54, 5 deep, 2 superficial) |
|
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| Satake et al. 2015 [39]‡,∗ | PC/NR | 207 | Not given | Open posterior instrumented thoracic, lumbar fusion | Vancomycin powder with fibrin glue (dosage NR) | 0% (0/59) | 6.08% (9/148) |
|
| |||||||
| Scheverin et al. 2015 [40]∗ | RC/pseudo-randomization | 513 | 18–78 | Degenerative/posterior instrumented lumbar fusion | Vancomycin powder 1 g mixed with bone graft | 1.29% (3/232) | 4.98% (14/281) |
|
| |||||||
| Strom et al. 2013 [41]∗ | RC/NR | 171 | Adult patients | Degenerative, infectious, neoplastic, trauma/posterior cervical instrumented fusion | Vancomycin powder 1 g | 2.53% (2/79) | 10.87% (10/92) |
|
| |||||||
| Strom et al. 2013 [42]∗ | RC/stratification | 165 | NRs | Degenerative, infectious, neoplastic, trauma/lumbar laminectomy and posterior instrumented fusion | Vancomycin powder 1 g | 0% (0/88) | 11.69% (9/77) |
|
| |||||||
| Suh et al. 2015 [43] | RCT/NR | 86 | 23–83 | Degenerative/posterior instrumented lumbar fusion | Vancomycin powder 2 g | 4.65% (2/43) | 2.33% (1/43) |
|
| |||||||
| Sweet et al. 2011 [44]‡,∗ | RC/NR | 1732 | 12–86 | Posterior instrumented thoracolumbar fusions | Vancomycin powder 2 g | 0.22% (2/911) | 2.56% (21/821) |
|
| |||||||
| Takeuchi et al. 2018 [45]d | RCT/randomization, blinding | 230 | NR | Deformity, degenerative, trauma/thoracic, lumbar fusion | Vancomycin powder 1 g | 1.72% (2/116, 1 deep, 1 superficial) | 2.63% (3/114, 1 deep, 2 superficial) |
|
| |||||||
| Takeuchi et al. 2019 [46]∗ | RC/NR | 668 | 16–89 | Degenerative, fracture/posterior spinal instrumentation | Vancomycin powder 1 g | 0.32% (1/314) | 2.54% (9/354) |
|
| |||||||
| Theologis et al. 2014 [47]∗ | RC/NR | 215 | 18–88 | Deformity/fusion greater than 3 levels | Vancomycin powder 2 g | 2.65% (4/151) | 10.93% (7/64) |
|
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| Tofuku et al. 2012 [48]‡,∗ | RC/NR | 384 | 7–89 | Degenerative, neoplastic, trauma, infectious/spinal instrumentation | 0.5 g Vancomycin-impregnated fibrin sealant | 0% (0/196) | 5.85% (11/188) |
|
| |||||||
| Tubaki et al. 2013 [49]‡ | RCT/randomization | 606 | 3–84 | Listhesis, disc prolapse/open instrumentation | Vancomycin powder 1 g | 1.99% (6/302) | 1.97% (6/304) |
Abbreviations: No., number; pts, patients; RCT, randomized controlled trial; PC, prospective cohort; RC, retrospective cohort; NR, not reported. aWe included only deep SSI that occurred in fusion cases. Superficial SSI were excluded because the paper reports that 5 occurred in both control and treatment groups, but the paper did not discern whether these occurred in instrumented or noninstrumented cases. bThere is another paper by O'Neill et al. that looked at only the spine trauma cases, but Dewan et al. look at the same trauma cases plus degenerative spine disease cases. The numbers included pertain to only the degenerative spine disease cases. cSample size reflects the propensity score matched cohorts. gControl group received ampicillin powder. ‡Only deep infections were reported in this study. ∗Studies showed a significant difference between the control and treatment groups.