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Old 01-31-2009, 05:59 PM
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Default Antibiotic Prophylaxis in Spine Surgery: An Evidence-based Clinical Guideline


Antibiotic Prophylaxis in Spine Surgery
North American Spine Society
Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care

The Spine Journal
Volume 9, Issue 2, February 2009, Pages 142-146

Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery

William C. Watters III MDa, , , Jamie Baisden MDb, Christopher M. Bono MDc, Michael H. Heggeness MD, PhDd, Daniel K. Resnick MDe, William O. Shaffer MDf and John F. Toton MDg

aBone & Joint Clinic, Ortho Spine, 6624 Fannin Street, Suite 2600, Houston, TX 77030-2312, USA
bMedical College of Wisconsin, Department of Neurosurgery, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226-3522, USA
cBrigham & Women's Hospital, Department of Ortho. Surgery, 75 Francis Street, Boston MA 02115-6110, USA
dBaylor College of Medicine, Orthopaedic Department, 1709 Dryden Road, Ste. 1230, Houston, TX 77030-2400, USA
eUniversity of Wisconsin Medical School, 600 Highland, Department Neurosurgery, K4/834 Clinical Science Center, Madison, WI 53792-0001, USA
fUniversity of Kentucky, 740 S. Limestone Street, Kentucky Clinic K-416, Lexington, KY 40536-0001, USA
g1310 Prentice Drive, Ste. G, Healdsburg, CA 95448-5005, USA


Background Context

The objective of the North American Spine Society's (NASS) Evidence-Based Clinical Guideline on Antibiotic Prophylaxis in Spine Surgery is to provide evidence-based recommendations on key clinical questions concerning the use of prophylactic antibiotics in spine surgery. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of December 2006. The goal of the guideline recommendations is to assist in delivering optimum, efficacious treatment to prevent surgical site infection.


To provide an evidence-based, educational tool to assist spine surgeons in preventing surgical site infections.

Study Design

Evidence-based Clinical Guideline.


This report is from the Antibiotic Prophylaxis Work Group of the NASS's Evidence-Based Clinical Guideline Development Committee. The work group comprised multidisciplinary surgical spine care specialists, who were trained in the principles of evidence-based analysis. Each member of the group formatted a series of clinical questions to be addressed by the group. The final questions agreed upon by the group are the subjects of this report. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE, EMBASE (Drugs and Pharmacology), and four additional, evidence-based, databases. The relevant literature was then independently rated by at least three reviewers using the NASS–adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final grades of recommendation for the answer to each clinical question were arrived at via Webcast meetings among members of the work group using standardized grades of recommendation. When Level I to Level IV evidence was insufficient to support a recommendation to answer a specific clinical question, expert consensus was arrived at by the work group through the modified nominal group technique and is clearly identified in the guideline.


Eleven clinical questions addressed the efficacy and appropriateness of antibiotic prophylaxis protocols, repeat dosing, discontinuation, wound drains, and special considerations related to the potential impact of comorbidities on antibiotic prophylaxis. The responses to these 11 clinical questions are summarized in this document. The respective recommendations were graded by the strength of the supported literature which was stratified by levels of evidence.


A clinical guideline addressing the use of antibiotic prophylaxis in spine surgery has been created using the techniques of evidence-based medicine and the best available evidence. This educational tool will assist spine surgeons in preventing surgical site infections. The entire guideline document, including the evidentiary tables, suggestions for future research, and references, is available electronically at the NASS Web site (Home) and will remain updated on a timely schedule.

Keywords: Antibiotic prophylaxis; Spine surgery; Surgical site infection; Evidence-based guideline

Copyright © 2009 Elsevier Inc. All rights reserved.
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