Single Dose Antibiotic Prophylaxis in Lumbar Stenosis or Disc Surgery: A Review of 117 Cases

Abstract

Background: Administration of prophylactic antibiotics for disc surgery is accepted by most surgeons, but no universal protocol exists. Objectives: To determine the safety and effectiveness of single dose preoperative antibiotics alone in preventing wound infections following single level lumbar laminectomy with or without discectomy. Patients and Methods: We reviewed 117 consecutive patients (68 males and 39 females) who underwent single-level lumbar laminectomy and medial facetectomy for lumbar stenosis, with or without discectomy during a ten-month period. Two grams of intravenous cefazolin was administered at the induction of general anesthesia. During the postoperative period, either in hospital or at home, additional antibiotic prophylaxis was not administered. The wounds were inspected on the first day of surgery at the time of indwelling catheter removal, 10-14 days after surgery for suture removal, and 4 to 6 weeks after discharge. Results: Superficial wound redness was detected in 2 patients (1.7%), which improved with oral antibiotic, and 1 patient (0.85%) developed discitis which improved with nonsurgical management. None of the patients needed surgical re-exploration for infection or other complications. Conclusions: The current retrospective study proved that our antibiotic prophylaxis protocol is safe and efficacious. Assuming that a wound infection rate of about 2% is considered acceptable after a clean spinal operation, a 1.7% rate for superficial incisional wound infections is promising. Also, as the incidence of discitis following discectomy has been reported to be between 0.75% and 3.0%, 0.85% rate of discitis in our series seems acceptable.