Interdisciplinary Neurosurgery (Sep 2020)
The effect of intradiscal vancomycin powder in the prevention of postoperative discitis: RCT study
Abstract
Background: Post discectomy discitis, although relatively uncommon (4%), is regarded as the most disabling cause of failed back surgery. We aimed to show the effect of intradiscal Vancomycin powder in reducing or preventing postoperative discitis in patients undergoing open or microscopic discectomy. Materials and methods: This is a prospective, randomized, comparative, multicentric study of 390 patients in which microscopic tubular disectomy was planned, either due to the failure of conservative treatment or due to the presence of a neurological deficit at the time of presentation. The patients were divided randomly into two groups. Group (A) included 192 cases, while group (B) included 198 cases. In the first group, a local Vancomycin powder was inserted into the disc space after finishing discectomy, and in the second group, nothing was inserted. The follow up was done by a third team, which did not know the patients’ grouping, so double blindness was applied. The follow up was done clinically, weekly for the first two weeks, then at the sixth week, and a three-month visit. In the case of any clinical findings suspicious of discitis during follow up, a laboratory and Contrast MRI study were requested. Outcome measures: We aimed to assess the effectiveness of intradiscal Vancomycin in discectomy operation, with attention to postoperative complications (discitis), by measuring CRP, ESR, WBC, blood culture, and contrast MRI in the postoperative period. Social habits (smoking & drinking alcohol) and past medical history (Diabetes Mellitus) have been taken into consideration. Result: The postoperative discitis was reported in 13 cases; of them, two patients were in the Vancomycin group (1.4%), while 11 patients were in the non-Vancomycin group (5.56%). Among the infected patients, L4-5 was the most common level (69.23%). Conclusion: We concluded that the intra-operative prophylaxis, with intradiscal Vancomycin, is effective in decreasing the incidence of postoperative discitis.
