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Does intrawound application of vancomycin influence bone healing in spinal surgery?
Claudia Eder1, Stefan Schenk2, Jana Trifinopoulos2
1Department of Spine Surgery, Spine Center, Orthopaedic Hospital Speising, Speisinger Str. 109, 1130, Vienna, Austria. Claudia.Eder@oss.at.
Purpose:
Surgical site infections represent a major complication of spinal surgery. The application of lyophilised vancomycin into the wound is reported to significantly decrease infection rates. As concentrations applied locally can exceed the minimal bacterial inhibitory concentration for more than a 1000-fold, toxic side effects on local tissue may be possible.
Methods:
Primary osteoblast cell cultures were generated from bone tissue samples of 10 patients. Samples were incubated in absence or presence of either 3, 6 or 12 mg/cm(2) vancomycin according to a planned phase I clinical trial protocol. Changes in pH, osteoblast migration, proliferation and viability were analysed. Alkaline phosphatase as well as mineralisation patterns was studied.
Results:
The application of more than 3 mg/cm(2) vancomycin induced a decline of pH. The migration potential of osteoblasts was decreased from 100% (control samples) to zero (12 mg/cm(2) vancomycin) in a dose-dependant manner. Cell proliferation was significantly inhibited at dosages above 3 mg/cm(2). Significant cell death was observed if the dosage applied exceeded 6 mg/cm(2). The synthesis of alkaline phosphatase was markedly reduced in all dosages applied and calcium deposition was significantly decreased in dosages above 3 mg/cm(2).
Conclusion:
As bone remodelling requires the immigration, proliferation and differentiation of osteoblasts at the fusion site, high dosages of intrawound vancomycin might interfere with regenerative processes and increase the risk of non-union. To allow an appropriate balance of infection risk and the risk of non-union, the minimal local concentration required should be determined by controlled in vivo studies.
Insights
High doses of intrawound vancomycin may harm bone healing after spinal surgery. Studies show it inhibits osteoblast function, potentially increasing non-union risks despite reducing infection rates.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Cell Biology
Background:
- Surgical site infections are a significant complication in spinal surgery.
- Local application of lyophilized vancomycin is effective in reducing infection rates.
- High local vancomycin concentrations may pose risks to local tissue.
Purpose of the Study:
- To investigate the potential toxic effects of intrawound vancomycin on osteoblasts.
- To evaluate the impact of varying vancomycin concentrations on osteoblast migration, proliferation, viability, and differentiation.
- To determine safe dosage limits for intrawound vancomycin in spinal surgery.
Main Methods:
- Primary osteoblast cell cultures were established from patient bone samples.
- Cells were exposed to vancomycin concentrations of 3, 6, and 12 mg/cm².
- Analysis included pH changes, cell migration, proliferation, viability, alkaline phosphatase synthesis, and mineralization.
Main Results:
- Vancomycin concentrations above 3 mg/cm² decreased pH and significantly inhibited osteoblast migration and proliferation.
- Cell death was observed at concentrations exceeding 6 mg/cm².
- Alkaline phosphatase synthesis and mineralization were reduced across all tested dosages, with significant decreases above 3 mg/cm².
Conclusions:
- High-dose intrawound vancomycin may impede bone healing by affecting osteoblast function, potentially increasing non-union risk.
- Further in vivo studies are needed to establish optimal vancomycin concentrations balancing infection prevention and bone healing.
- Careful consideration of vancomycin dosage is crucial to avoid compromising spinal fusion outcomes.
