Vacuum Assisted Closure and Local Drug Delivery Systems in Spinal Infections A review of current evidence

Narrative review Spinal infections are still showing increased incidence throughout the years as our surgical capabilities increase, coupled with an overall aging population with greater number of chronic comorbidities. The management of spinal infection is of utmost importance, due to high rates of morbidity and mortality, on top of the general difficulty in eradicating spinal infection due to the ease of hematogenous spread in the spine. We aim to summarise the utility of Vacuum Assisted Closure (VAC) and Local Drug Delivery Systems (LDDS) in the management of spinal infections. A narrative review was conducted. All studies that were related to the use of VAC and LDDS in Spinal Infections were included in the study. A total of 62 studies were included in this review. We discussed the utility of VAC as a tool for management of wounds requiring secondary closure, as well as how it is increasingly being used after primary closure as prophylaxis for surgical site infections (SSIs) in high-risk wounds of patients undergoing spinal surgery. The role of LDDS in spinal infections was also discussed, with preliminary studies showing good outcomes when patients were treated with various novel LDDS. We have summarised and given our recommendations for the use of VAC and LDDS for spinal infections. A treatment algorithm has also been established, to act as a guide for spine surgeons to follow when tackling various spinal infections in day-to-day clinical practice.