Practice preference and evidence analysis on topical use of tobramycin powder in lumbar spine surgery: A Multi-National AO spine survey with systematic review of the literature

Veranis Sotiris; Sathish Muthu; Matt Gary; Sam Cho; So Kato; Stephen J Lewis; Ho-Joong Kim; Jeffrey Wang; Amit Jain; S Tim Yoon; AO Spine Knowledge Forum Degenerative

doi:10.1016/j.wnsx.2024.100397

Practice preference and evidence analysis on topical use of tobramycin powder in lumbar spine surgery: A Multi-National AO spine survey with systematic review of the literature

World Neurosurg X. 2024 Sep 26:24:100397. doi: 10.1016/j.wnsx.2024.100397. eCollection 2024 Oct.

Authors

Veranis Sotiris¹, Sathish Muthu^{2

3

4}, Matt Gary⁵, Sam Cho⁶, So Kato⁷, Stephen J Lewis⁸, Ho-Joong Kim⁹, Jeffrey Wang¹⁰, Amit Jain¹¹, S Tim Yoon¹²; AO Spine Knowledge Forum Degenerative

Affiliations

¹ Department of Neurosurgery, General Air Force General Staff Hospital, Athens, Greece.
² Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
³ Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India.
⁴ Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India.
⁵ Departments of Neurosurgery and Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
⁶ Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁷ Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
⁸ UHN-Orthopedics, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
⁹ Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea.
¹⁰ Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, CA, USA.
¹¹ Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
¹² Department of Orthopaedics, Emory University, Atlanta, GA, USA.

Abstract

Study design: Cross-sectional study with systematic review of literature.

Objective: There is an increasing interest in the topical use of antibiotics to prevent infection following spine surgery. To extend the antibiotic coverage to the gram-negative spectrum, the usage of tobramycin powder is being considered. We surveyed to analyze the current practice preference on the use of topical tobramycin in lumbar spine surgery and also aimed to analyze the literature for current evidence on the same.

Methods: A multinational cross-sectional survey was conducted among AO Spine members worldwide to understand the use of topical tobramycin in 1 or 2-level open lumbar fusion surgeries. Also, an independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed by two authors to identify relevant articles in adherence to the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting the usage of tobramycin in lumbar spine surgeries were included for analysis.

Results: Among the 231 participating surgeons, only 1.7 %(n = 4) reported utilizing tobramycin in 1 or 2-level open lumbar fusion surgery. Upon systematic review of the literature, two studies with 484 patients were included for analysis. With the usage of tobramycin as a topical antibiotic powder, both studies noted a reduction in the incidence of infection with change in the spectrum of infective organisms.

Conclusion: Topical Tobramycin is not the commonly preferred topical antibiotic to prevent SSI among spine surgeons worldwide. There is a lack of sufficient evidence to support the routine use of topical tobramycin in lumbar spine surgery.

Keywords: Gram-negative; Spine surgery; Surgical site infection; Tobramycin; Topical antibiotics.

Publication types

Review