J Neurosurg Spine 43:509–518, 2025
A meta-analysis of seven randomized controlled trials found that intraoperative vancomycin use in open spine surgery did not significantly reduce rates of superficial or deep surgical site infections. Further large-scale studies are needed to clarify its efficacy and inform clinical guidelines.
• A systematic review and meta-analysis of 7 randomized controlled trials (RCTs) with 2235 patients assessed the efficacy of intraoperative vancomycin in preventing infections after open spine surgery.
• No significant reduction in overall surgical site infections (SSI), deep infections, or superficial infections was found with intraoperative vancomycin compared to control.
• Subgroup analyses showed no benefit in either instrumented or uninstrumented spine surgeries.
• There was no significant shift toward gram-negative or culture-negative infections with vancomycin use.
• Potential risks include local cytotoxicity and possible impairment of bone healing and spinal fusion.
• Current evidence is limited by small sample sizes, heterogeneity in vancomycin administration, and variable follow-up durations.
• The study concludes intraoperative vancomycin may not reduce infection risk and further large RCTs are warranted.
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