Abstract
Intra-operative incidental contamination of surgical wounds is not rare. Povidone-iodine solution can be used to disinfect surgical wounds. Although povidone-iodine is a good broad-spectrum disinfecting agent, it has occasionally been reported to have a negative effect on wound healing and bone union. Therefore, its safety in a spinal surgery is unclear. A prospective, single-blinded, randomized study was accordingly conducted to evaluate the safety of povidone-iodine solution in spinal surgeries. Ascertained herein was the effect of wound irrigation with diluted povidone-iodine solution on wound healing, infection rate, fusion status and clinical outcome of spinal surgeries. Materials and methods: From January 2002 to August 2003, 244 consecutive cases undergoing primary instrumented lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability had been collected and randomly divided into two groups: the study group (120 cases, 212 fusion levels) and the control group (124 cases, 223 fusion levels). Excluded were those patients with a prior spinal surgery, spinal trauma, malignant tumor, infectious spondylitis, rheumatoid arthritis, ankylosing spondylitis, metabolic bone disease, skeletal immaturity or with an immunosuppressive treatment. In the former group, wounds were irrigated with 0.35% povidone-iodine solution followed by normal saline solution just before the bone-grafting and instrumentation procedure. However, only with normal saline solution in the latter. All the operations were done by the same surgeon with a standard technique. All the patients were treated in the same postoperative fashion as well. Later on, wound healing, infection rate, spinal bone fusion and clinical outcome were evaluated in both groups. Results: A significant improvement of back and leg pain scores, modified Japanese Orthopedic Association function scores (JOA) and ambulatory capacity have been observed in both groups. One hundred and seven patients in the study group and one hundred and nine in the control group achieved solid union. There was no infection in the study group but six deep infections in the control group. Wound dehiscence was noted in one group 1 and two group 2 patients. A subsequent statistical analysis revealed higher infection rate in the control group (P<0.05), but no significant difference in fusion rate, wound healing, improvement of pain score, function score and ambulatory capacity between the two groups. Conclusion: Diluted povidone-iodine solution can be used safely in spinal surgeries, and it will not influence wound healing, bone union and clinical outcome.
Similar content being viewed by others
References
Abbey DM, Turner DM, Warson JS et al (1995) Treatment of postoperative wound infections following spinal fusion with instrumentation. J Spinal Disord 4:278–283
Branemark PI, Ekholm E (1967) Tissue injury caused by wound disinfectants. J Bone Joint Surg Am 49A:48–62
Champagne CM, Cooper LF, Offenbacher S et al (2002) Macrophage cell lines produce osteoinductive signals that include bone morphogenetic protein-2. Bone 30(1):26–31
Emery SE, Hughes SS, Junglas WA et al (1994) The fate of anterior vertebral bone grafts in patients irradiated for neoplasm. Clin Orthop 300:207–212
Fischgrund JS, Machay M, Herkowitz HN et al (1997) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812
Fumal I, Braham C, Paquet P et al (2002) The beneficial toxicity paradox of antimicrobials in leg ulcer healing impaired by a polymicrobial flora: a proof-of-concept study. Dermatology 204S1:70–74
Gruber R, Vistnes L, Pardoe R (1975) The effect of commonly used antiseptics on wound healing. Plast Reconstr Surg 55:472–476
Haines SJ (1982) Topical antibiotic prophylaxis in neurosurgery. Neurosurgery 11(2):250–253
Haley CE, Marling-Cason, Smith JW et al (1985) Bactericidal activity of antiseptics against methicillin-resistant stapholococcus aureus. J Clin Microbiol 21(6):991–992
Jackson RK, Boston DA, Edge AJ (1985) Lateral mass fusion. A prospective study of a consecutive series with long-term follow-up. Spine 10:828–832
Kaysinger KK, Nicholson NC, Ramp WK et al (1995) Toxic effects of wound irrigation solutions on cultured tibiae and osteoblasts. J Orthop Trauma 9(4):303–311
Kjolseth D, Barker JH, Barker JH et al (1994) Comparison of the effects of commonly used wound agents on epithelialization and neovascularization. J Am Coll Surg 179:305–312
Klekamp J, Spengler DM, McNamara MJ et al (1999) Risk factors associated with methicillin-resistant staphylococcal wound infection after spinal surgery. J Spinal Disord 12(3):187–191
Kozo Okada, Shiro Oka, Kenji Tohge et al (1991) Thoracic myelopathy caused by ossification of the ligamentum flavum. Spine 16:280–287
Kunisada T, Yamada K, Hara O et al (1997) Investigation on the efficacy of povidone-iodine against antiseptic-resistant species. Dermatology 195S2:14–18
Lenke LG, Bridwell KH, Blanke K et al (1995) Prospective analysis of nutritional status normalization after spinal reconstructive surgery. Spine 20:1359–1367
Lineaweaver W, Howard R, Soucy D et al (1985) Topical antimicrobial toxicity. Arch Surg 120:267–270
Lineaweaver W, McMorris S, Soucy D et al (1985) Cellular and bacterial toxicities of topical antimicrobials. Plast Reconstr Surg 75:394–396
Linovitz RJ, Pathria M, Bernhardt M et al (2002) Combined magnetic fields accelerate and increase spine fusion. Spine 12:1383–1389
Lonstein J, Winter R, Moe J et al (1973) Wound infection with Harrington instrumentation and spine fusion for scoliosis. Clin Orthop 96:222–233
Maguire WB (1964) The use of antibiotics, locally and systemically, in orthopedic surgery. Med J Aust 12(52):412–414
Massie JB, Heller JG, Abitbol JJ et al (1992) Postoperative posterior spinal wound infections. Clin Orthop 284:99–108
Moore K, Thomas A, Harding KG (1997) Iodine released from the wound dressing iodosorb modulates the secretion of cytokines by human macrophages responding to bacterial lipopolysaccharide. Int J Biochem Cell Biol 29(1):163–171
Mulliken J, Healey N, Glowacki J (1980) Povidone-iodine and tensile strength of wounds in rats. J Trauma 20:323–324
Nachmie BA, Siffert RS, Bryer MS (1968) A study of neomycin instillation into orthopedic surgical wounds. JAMA 204:687–689
Niedner R (1997) Cytotoxicity and sensitization of povidone-iodine and other frequently used anti-infective agents. Dermatology 195S2:89–92
Nilsson OS, Bauer HCF, Brostrom LA (1987) Methotrexate effects on heterotopic bone in rats. Acta Orthop Scand 58:47–53
Penning L, Blickman JR (1980) Instability in lumbar spondylolisthesis: a radiologic study of several concepts. AJR Am J Roentgenol 134:293–301
Rappolee DA, Werb Z (1992) Macrophage-derived growth factors. Curr Top Microbiol Immunol 181:87–140
Robbins P, Day CL Jr, Lew RA (1984) A multivariate analysis of factors affecting wound-healing time. Dermatol Surg Oncol 10:219–222
Robinson RA, Walker AE, Ferlic DC et al (1962) The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg 44A:1569–1587
Rosenstein BD, Wilson FC, Funderburk CH (1989) The use of bacitracin irrigation to prevent infection in postoperative skeletal wounds. J Bone Joint Surg Am 70A:427–430
Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 203:7–17
Scherr DD, Dodd TA (1976) In vitro bacteriological evaluation of the effectiveness of antimicrobial irrigation solutions. J Bone Joint Surg Am 58A:119–122
Scherr DD, Dodd TA, Buckingham WW Jr (1972) Prophylactic use of topical antibiotic irrigation in uninfected surgical wounds. J Bone Joint Surg Am 54A:634–640
Schmitt JM, Hwan K, Winn SR et al (1999) Bone morphogenetic proteins: An update on basic biology and clinical relevance. J Orthop Res 17:269–278
Schreier H., Erdos G, Fleischer W et al (1997) Molecular effects of povidone-iodine on relevant microorganisms: an electron-microscopic and biochemical study. Dermatology 195S2:111–116
Silcox DH, Daftari D, Boden SD et al (1995) The effect of nicotine on spinal fusion. Spine 20:1549–1553
Sindelar WF, Mason GR (1977) Efficacy of povidon-iodine irrigation in prevention of surgical wound infections. Surg Forum 28:48–51
Steinmann JC, Herkowitz HN (1992) Pseudarthrosis of the spine. Clin Orthop 284:80–89
Tronnier V, Schneider R, Kunz U et al (1992) Postoperative spondylodiscitis after operation for lumbar disc herniation. Acta Neurochirurgica 117:149–152
Vaughan PA, Malcolm BW, Maistrelli GL (1988) Results of L4-L5 disc excision alone versus disc excision and fusion. Spine 13:690–699
Wimmer C, Gluch H, Franzreb M et al (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11(2):124–128.
Zdeblick TA (1993) A prospective, randomized study of lumbar fusion—preliminary results. Spine 18:983–991
Acknowledgements
The manuscript does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this manuscript. We thank Miss Hui-Chen Lee, Division of Experimental Surgery, for her help in stastistic analysis.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chang, FY., Chang, MC., Wang, ST. et al. Can povidone-iodine solution be used safely in a spinal surgery?. Eur Spine J 15, 1005–1014 (2006). https://doi.org/10.1007/s00586-005-0975-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-005-0975-6