ArticleSpine surgery and related research2026
Effect of Cyanoacrylate Microbial Sealant on Intraoperative Bacterial Contamination in Spine Surgery: A Prospective Consecutive Study.
Article in Spine surgery and related research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Surgical site infection (SSI) remains a significant complication in spinal surgery, particularly in instrumented procedures. While modern skin antisepsis and antibiotic prophylaxis reduce infection risk, microbial ingress from residual skin flora persists. Cyanoacrylate-based microbial sealants have shown promise in other surgical fields, but their efficacy in spinal surgery remains unclear. This study aimed to evaluate whether a cyanoacrylate microbial sealant could reduce postoperative drain colonization, an established surrogate marker for early bacterial contamination. Methods: A prospective study was conducted on 160 consecutive spinal surgeries at a single tertiary spine center. Patients were divided into two groups: 80 received standard skin preparation alone (control), and 80 received additional application of a microbial sealant (Guardiseal) after skin preparation. Drain-tip cultures were obtained upon removal (average postoperative day 2) and analyzed microbiologically. The primary outcome was the rate of positive drain-tip culture (≥20 colony-forming units); secondary outcomes included SSI incidence within 90 days. Standard perioperative protocols were maintained across both groups. Results: Positive drain-tip cultures occurred in 8 of 160 cases (5.0%), with a significantly lower rate in the sealant group than in the control group (1 of 80 [1.3%] vs. 7 of 80 [8.8%], p=0.029). SSI was confirmed in two patients (one superficial, one deep), both microbiologically concordant with drain-tip cultures. The sensitivity and negative predictive value of drain-tip cultures for SSI were 100% in both groups; the positive predictive value was 100% in the sealant group and 29% in the control group. No adverse effects or workflow issues were observed with sealant use. Conclusions: Use of a cyanoacrylate microbial sealant in spinal surgery significantly reduced postoperative drain colonization without adverse effects. While SSI rates remained unchanged, the microbiological benefits suggest that sealants may serve as a valuable adjunct to infection prevention strategies. Further large-scale, randomized studies are warranted.
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