Introduction: Postoperative surgical site infections (SSIs) are associated with worse patient outcomes and increased healthcare burden. The posterior cervical spine surgery approach has an increased wound healing complication profile compared to anterior approaches. Negative pressure wound therapy (NPWT) is often used for complex, non-healing or at-risk wounds. However, limited data exists on prophylactic NPWT benefits in posterior cervical spine surgery. We sought to evaluate whether prophylactic NPWT reduces SSIs and other complications in posterior cervical laminectomy and fusion patients.
Methods: We conducted a single institution retrospective cohort study evaluating the impact of incisional negative pressure wound vacuum dressings on outcomes following posterior cervical surgery for degenerative, traumatic and pathologic cervical spinal stenosis between August 2021 and April 2024. Two cohorts were generated by reviewing all patients who underwent posterior cervical laminectomy and fusion by six spine attendings at our institution. After exclusion of patients who had concurrent anterior surgery, the control cohort yielded 37 patients and the experimental (NPWT) cohort had 19 patients. We collected data from the electronic medical record including demographics, intraoperative parameters, and post-operative outcomes.
Results: Patient demographics were similar between the control and NPWT cohorts. Intra and post-operative data including ASA score, time from consultation to surgery, length of surgery, number of operated levels, and LOS were similar between cohorts. Post-operative ICU admissions were significantly higher in the NPWT cohort (78.9 vs 35.1%; p = 0.001). Post-operative outcomes including reoperation rates were similar in patients regardless of whether they received NPWT. Incidence of SSI was higher, though not significantly, in patients who received NPWT vs non-NPWT (5.3% vs 0%, respectively; p = 0.159).
Conclusion : We present one of the few studies evaluating prophylactic incisional NPWT in posterior cervical decompression and instrumented fusion spine surgery. While there were no statistically significant differences in SSI rates between cohorts, we paradoxically found an increased rate in the NPWT cohort. This may be explained by an uncaptured worse baseline characteristic in the NPWT group as they had a higher rate of ICU admissions. Future prospective studies may be useful as NPWT has been beneficial in other settings.
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