Neurospine

Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study: Gun-Ill Lee, Koang Hum Bak, Hyoung-Joon Chun, Kyu-Sun Choi; Korean J Spine 2016;13(2):47-52. Published online June 30, 2016; DOI: https://doi.org/10.14245/kjs.2016.13.2.47

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Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study

Korean J Spine. 2016;13(2):47-52. Published online June 30, 2016

DOI: https://doi.org/10.14245/kjs.2016.13.2.47

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Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study

Korean J Spine. 2016;13(2):47-52. Published online June 30, 2016

DOI: https://doi.org/10.14245/kjs.2016.13.2.47

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Objective

We conducted this study to report the efficacy of local application of vancomycin powder in the setting of surgical site infection (SSI) of posterior lumbar surgical procedures and to figure out risk factors of SSIs.

Methods

From February 2013 to December 2013, SSI rates following 275 posterior lumbar surgeries of which intrawound vancomycin powder was used in combination with intravenous antibiotics (Vanco group) were assessed. Compared with 296 posterior lumbar procedures with intravenous antibiotic only group from February 2012 to December 2012 (non-Vanco group), various infection rates were assessed. Univariate and multivariate analysis to figure out risk factors of infection among Vanco group were done.

Results

Statistically significant reduction of SSI in Vanco group (5.5%) from non-Vanco group (10.5%) was confirmed (p=0.028). Mean follow-up period was 8 months. Rate of acute staphylococcal SSIs reduced statistically significantly to 4% compared to 7.4% of non-Vanco group (p=0.041). Deep staphylococcal infection decreased to 2 compared to 8 and deep methicillin-resistant Staphylococcus aureus infection also decreased to 1 compared to 5 in non-Vanco group. No systemic complication was observed. Statistically significant risk factors associated with SSI were diabetes mellitus, history of cardiovascular disease, length of hospital stay, number of instrumented level and history of previous surgery.

Conclusion

In this series of 571 patients, intrawound vancomycin powder usage resulted in significant decrease in SSI rates in our posterior lumbar surgical procedures. Patients at high risk of infection are highly recommended as a candidate for this technique.

Citations

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The Effect of Early Percutaneous Vertebroplasty in Occult Osteoporotic Vertebral Fracture.: Jae Chang Song, Koang Hum Bak, Dong Charn Cho, Hyun Jong Hong, Jae Min Kim, Chung Hyun Kim; Korean J Spine 2008;5(3):173-177.

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The Effect of Early Percutaneous Vertebroplasty in Occult Osteoporotic Vertebral Fracture.

Korean J Spine. 2008;5(3):173-177.

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The Effect of Early Percutaneous Vertebroplasty in Occult Osteoporotic Vertebral Fracture.

Korean J Spine. 2008;5(3):173-177.

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OBJECTIVE
Recently, the definition of occult osteoporotic vertebral fracture has been established, and its clinical significance has come to our interest. We report the effect of early percutaneous vertebroplasty in occult osteoporotic vertebral fracture.
METHODS
From January 2006 to January 2008, we performed percutaneous vertebroplasty for 50 levels in 47 patients. 21 levels (21 patients) of them were classified into occult osteoporotic vertebral fracture group, 29 levels (26 patients) were categorized into control group (not occult osteoporotic vertebral fracture) by the Pham T..s criteria. We obtained VAS score and measured the compression ratio at first hospital day and 1 day, 1 month, 3 months after procedure.
RESULTS
There are noticeable improvements in VAS score. The mean VAS score at admission was 6.44 in occult group and 6.15 in control group, which changed 2.23 in occult group and 2.68 in control group after procedure. The compression rate was 1.008, 1.018, 1.016 in occult group and 0.862, 0.891, 0.881 in control group at admission and 1 month, 3 months after procedure. The conservative effect for vertebral height was higher than control group (p=0.011).
CONCLUSION
Percutaneous vertebroplasty in occult osteoporotic compression fracture provided significant pain relief and conservative effect for vertebral height. It is probable that it can lower the rate of secondary adjacent vertebral compression fracture.

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Post-augmentation Burst Fracture at the Same Fractured Vertebra.: Jaewoo Chung, Hyoung Joon Chun, Hyeong Joong Yi, Koang Hum Bak, Young Soo Kim, Yong Ko; Korean J Spine 2010;7(1):37-40.

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Post-augmentation Burst Fracture at the Same Fractured Vertebra.

Korean J Spine. 2010;7(1):37-40.

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Post-augmentation Burst Fracture at the Same Fractured Vertebra.

Korean J Spine. 2010;7(1):37-40.

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A 56-year-old woman was admitted for management of low back pain from compression fracture on L3 vertebral body. Vertebroplasty was performed, and she discharged without any neurologic deficit. She revisited our institute with low back pain with sciatica but without myelopathy after three months. At admission image studies revealed fractured bony particles caused canal encroachment on the same level vertebrae. Surgical management was perfor- med including wide posterior decompression and transpedicular screw fixation on L2, L3, and L4 with posterolateral bony fusion. Authors present a rare case of post-augmentation fracture led to spinal fusion. Additionally, we suggest that filling material for vertebroplasty or kyphoplasty should be, as much as possible, inserted into the posterior half of vertebral body to prevent the refracture or burst fracture.