Practice preference and evidence analysis on topical use of tobramycin powder in lumbar spine surgery: A Multi-National AO spine survey with systematic review of the literature.

Study design: Cross-sectional study with systematic review of literature. Objective: There is an increasing interest in the topical use of antibiotics to prevent infection following spine surgery. To extend the antibiotic coverage to the gram-negative spectrum, the usage of tobramycin powder is being considered. We surveyed to analyze the current practice preference on the use of topical tobramycin in lumbar spine surgery and also aimed to analyze the literature for current evidence on the same. Methods: A multinational cross-sectional survey was conducted among AO Spine members worldwide to understand the use of topical tobramycin in 1 or 2-level open lumbar fusion surgeries. Also, an independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed by two authors to identify relevant articles in adherence to the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting the usage of tobramycin in lumbar spine surgeries were included for analysis. Results: Among the 231 participating surgeons, only 1.7 %( Conclusion: Topical Tobramycin is not the commonly preferred topical antibiotic to prevent SSI among spine surgeons worldwide. There is a lack of sufficient evidence to support the routine use of topical tobramycin in lumbar spine surgery.