Surgical Site Infection (SSI) with and without suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion.

Abstract

Objective: To evaluate the incidence of surgical site infections (SSI) with and without the use of suprafascial intrawound vancomycin powder in instrumented posterior spinal fusion. Study Design: Randomized Controlled Trial. Setting: Department of Neurosurgery, Allied Hospital-I, Faisalabad. Period: 01-01-2026 to 30-06-2026. Methods: We randomly assigned 74 patients from each group to undergo posterior spinal instrumentation; the patients' ages ranged from 18 to 65. In addition to the usual prophylactic intravenous antibiotics, Group A also got intrawound vancomycin powder. In contrast, Group B only received intravenous antibiotics. Over the course of three months, patients were monitored for the occurrence of SSI, as defined by the CDC. A chi-square test was used to compare the SSI rates between the groups, and the data were analyzed using SPSS version 25.0. Results: The overall frequency of SSI was 13.5% (20/148). Group A showed a significantly lower rate of SSI (6.8%) compared to Group B (20.3%) (p = 0.016). Among infections, 8.8% were superficial and 4.7% were deep. Stratified analysis demonstrated a consistent reduction in SSI in the vancomycin group across most subgroups. Conclusion: Suprafascial intrawound application of vancomycin powder significantly reduces postoperative SSI in instrumented posterior spinal fusion and may be considered an effective, safe, and cost-efficient adjunct to standard antibiotic prophylaxis.