Moderators: Clinton Devin, MD; Jason Savage, MD
Surgical-site infections (SSIs) after spine surgery occur in 1-10 percent of patients, and are often associated with increased postoperative morbidity, mortality, health care costs and poor clinical outcomes. Risk factors have been identified that are associated with an increased risk of developing postoperative wound infections, which include smoking, obesity, diabetes, long term steroid use, alcohol abuse, malnutrition, history of prior infection, and increased operative time and/or estimated blood loss.
The use of local vancomycin powder in spine surgery has been popularized over the past decade in an effort to minimize the risk of developing a SSI. The data behind its use is compelling, although there is uncertainty regarding the potential “side effects or pitfalls” of it use, such as developing microbial resistance, selecting out gram negative bacteria, and/or adverse effects on osteoblast function and achieving spinal fusion. Furthermore, little is known about the adverse effects of SSI on bone graft substitutes or extenders, and the “ideal” treatment of SSI in the setting of spinal instrumentation remains unclear.
The purpose of this symposium is to review the evidence behind the use of vancomycin powder in spine surgery, as well as to discuss the potential pitfalls of its use, and to explore the potential interaction between spinal implants, including bone graft substitutes and infection.
Upon completion of this session, participants should gain strategies to:
- Discuss the potential pitfalls of using local vancomycin powder, including systemic uptake and side effects, microbial resistance, and selection of gram negative bacteria and/or VRE;
- Discuss the effect of vancomycin powder on osteoblast function and fusion;
- Discuss the interaction between implants and infection, the use of BMP in setting of infection (osteomyelitis, SSI), when to retain or remove instrumentation and how to handle bone grafts and/or extenders in the setting of infection.
Agenda
Introduction
Clinton Devin, MD and Jason Savage, MD
Evidence Behind the Use of Vancomycin Powder in Spine Surgery
Jason Savage, MD
Potential Pitfalls of Using Local Vancomycin Powder
Karen Bloch
Effect of Vancomycin Powder on Osteoblast Function and Fusion
Brandon Lawrence, MD
Interaction Between Implants and Infection
Paul Anderson, MD
Case Presentation and Discussion