Intraoperative powdered vancomycin use with paddle lead placement.

OBJECTIVES This is a prospective case-control study that was conducted to determine if the addition of intraoperative powdered vancomycin placed directly into the wounds at the time of closure might decrease the rate of acute postoperative infection after the placement of spinal cord stimulator paddle leads. MATERIALS AND METHODS A retrospective analysis of the author's practice from January 1, 2009 through July 31, 2012 (Table 1) showed that those patients requiring a laminectomy instead of a laminotomy to insert a paddle lead had an increased rate of acute postop infection. All patients receiving a thoracic spinal cord stimulator paddle from January 1, 2013 through December 31, 2013 were then followed prospectively. Those patients whose paddle leads could be inserted with a laminotomy were treated in a standard fashion. Those patients who required a laminectomy for insertion of the paddle lead received powdered vancomycin placed directly into the wounds prior to closure. RESULTS One hundred and nine patients underwent implantation of a permanent spinal cord stimulator paddle lead and battery between January 1 and December 31, 2013. Thirty-two of those patients required a laminectomy for implantation of the paddle and received intraoperative powdered vancomycin placed directly into both wounds at the time of closure. The remaining 77 patients were treated in a standard fashion. There were no infections in the laminectomy group and two infections in the laminotomy group. CONCLUSION This study indicates that intraoperative powdered vancomycin placed directly into the wounds at the time of closure can produce similar infection rates between the groups of patients requiring a laminectomy vs. a laminotomy for implantation of a thoracic paddle lead. These findings need confirmation by a randomized controlled design study.