Intraoperative powdered vancomycin use with paddle lead placement

Area of Science:

• Neurosurgery
• Infectious Disease Prevention

Background:

• Spinal cord stimulator (SCS) lead placement can lead to acute postoperative infections.
• Laminectomy, a surgical approach for SCS paddle lead insertion, has been associated with a higher infection rate compared to laminotomy.

Purpose of the Study:

• To investigate the efficacy of intraoperative powdered vancomycin in reducing acute postoperative infections following SCS paddle lead implantation.
• To compare infection rates between patients undergoing laminectomy with vancomycin and those undergoing standard procedures.

Main Methods:

• A prospective case-control study design was employed.
• Patients receiving thoracic SCS paddle leads were analyzed.
• The laminectomy group (n=32) received intraoperative powdered vancomycin, while the laminotomy group (n=77) received standard care.

Main Results:

• No infections were reported in the group that received intraoperative powdered vancomycin during laminectomy.
• Two infections occurred in the standard care (laminotomy) group.
• This suggests a potential protective effect of vancomycin in the laminectomy group.

Conclusions:

• Intraoperative powdered vancomycin may help equalize infection rates between laminectomy and laminotomy procedures for thoracic paddle lead implantation.
• Further confirmation through randomized controlled trials is warranted to validate these findings.