Drain blockage by topical vancomycin powder—a case report of a potentially catastrophic complication in spine surgery

BACKGROUND: There is evidence that application of vancomycin powder reduces the incidence of surgical site infection (SSI) and is also effective for the treatment of infections requiring surgical debridement. The use of intrawound vancomycin powder is therefore becoming prevalent. Surgical drain occlusion by antibiotic powder is a potentially serious complication that has yet to be reported in the literature. CASE DESCRIPTION: We describe a 62-year-old female with L4/5 spondylodiscitis as well as an L1–S1 epidural abscess who presented with back pain, lower limb numbness and weakness. Urgent surgical drainage was performed via a hemilaminectomy and L4/5 diskectomy. Drain output was absent for the first 36 hours post-op, and upon inspection and disconnection of the distal drain tubing, vancomycin powder residue was noted to be deposited within the lumen and connection point to cause complete obstruction. Following tubing exchange, drainage output resumed. The patient experienced relief of her back and leg symptoms after surgery as well as a normalization of her inflammatory markers upon receiving a course of intravenous (IV) antibiotics. CONCLUSIONS: Drain occlusion from antibiotic powder may be catastrophic following spine surgery due to the risk of epidural hematoma formation followed by compression of neural elements. We review the physicochemical properties of vancomycin powder and discuss ways to prevent this complication from occurring.