Tag: Evidence-based medicine

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Intraoperative vancomycin for preventing infection after open spine surgery: a systematic review and meta-analysis of randomized controlled trials

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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Towards Evidence-Based Guidelines in Neurological Surgery

DOI:10.1093/neuros/nyy414

Neurological surgery practice is based on the science of balancing probabilities. A variety of clinical guidance documents have influenced how we collectively practice our art since the early 20th century. The quality of the science within these guidelines varies widely, as does their utility in positively shaping our practice.

The guidelines development process in neurological surgery has evolved significantly over the last 30 yr. Historically based in expert opinion, as a specialty we have increasingly relied on objective medical evidence to guide our clinical practice. We assessed the changing practice guidelines development process and the impact of scientifically robust guidelines on patient care.

The evolution of the guidelines development process in neurological surgery was chronicled. Several subspecialty guidelines were extracted and reviewed in detail. Their impact on practice patterns was evaluated. The importance of evidence-based research and practice guidelines development was discussed.

Evidence-based practice guidelines serve to chronicle multiple acceptable treatment options and help us move towards more standardized care for specific disease processes. Theyhelprefutefalse“standardsofcare.” Guidelines-basedcaresupportedbysolidmedical evidence has the potential to streamline patient care and improve patient outcomes. The guidelines development process identifies areas, issues, and strategies for which little medical evidence exists, as well as topics that need focused scientific investigation and future study.

The production of evidence-based practice recommendations is a vital part of furthering our specialty. Guidelines development advances our science, augments the resident education process, and protects our practice from undue external influence.

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Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition

Neurosurgery 80:6–15, 2017

The scope and purpose of this work is 2-fold: to synthesize the available evidence and to translate it into recommendations. This document provides recommendations only when there is evidence to support them. As such, they do not constitute a complete protocol for clinical use.

Our intention is that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insu cient.

We think it is important to have evidence-based recommendations to clarify what aspects of practice currently can and cannot be supported by evidence, to encourage use of evidence-based treatments that exist, and to encourage creativity in treatment and research in areas where evidence does not exist.

The communities of neurosurgery and neuro-intensive care have been early pioneers and supporters of evidence-based medicine and plan to continue in this endeavor. The complete guideline document, which summarizes and evaluates the literature for each topic, and supplemental appendices (A-I) are available online at https://www.braintrauma.org/coma/guidelines.

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