Authors/year Study design/method of controlling for bias No. of pts Age range of pts Included spinal diagnoses/procedures Intervention Wound infection rates in treatment group Wound infection rates in control group Adhikari et al. 2020 [20 ]‡ RC/NR 141 Adults Deformity, degenerative, trauma, neoplastic/posterior instrumented fusion Vancomycin powder 1 g 3.53% (3/85) 1.79% (1/56) Caroom et al. 2013 [21 ] RC/NR 112 NR Cervical spondylotic myelopathy/posterior instrumented fusion Vancomycin powder 1 g 0% (0/40) 15.28% (11/72) Dewan et al. 2013 [22 ]a, RC/NR 455 NR Degenerative/posterior spinal fusion Vancomycin powder 1 g 0% (0/137) 5.66% (18/318) Ehlers et al. 2016 [23 ]b PC/propensity score matching 6910 NR Instrumented cervical or lumbar fusion Intrawound antibiotics (type and dose NR) 0.93% (32/3455) 1.30% (45/3455) Emohare et al. 2014 [24 ]c RC/multivariate analysis, pseudo-randomization by surgeond 200 NR Degenerative/posterior instrumented thoracic, thoracolumbar, lumbar fusion Vancomycin powder 1 g 0% (0/78) 3.28% (4/122) Gaviola et al. 2016 [25 ] RC/multivariate analysis 326 40–71 Instrumented multilevel fusion Vancomycin powder 2 g 5.17% (6/116) 11.0% (23/210) Haimoto et al. 2018 [26 ] RC/NR 515 18 and above Posterior instrumented cervical, thoracic, lumbar fusion Vancomycin powder 1 g 0% (0/247) 5.60% (15/268) Heller et al. 2015 [27 ]‡ RC/NR 683 NR Degenerative, deformity, neoplastic, others/posterior instrumented fusion Vancomycin powder 0.5–2 g 2.63% (9/342) 5.28% (18/341) Hey et al. 2017 [28 ] RC/multivariate analysis, pseudo-randomization 389 11–85 Degenerative, trauma, neoplastic/open instrumentation Vancomycin powder 1 g 0.85% (1/117, 1 deep) 6.25% (17/272, 10 deep, 7 superficial) Horii et al. 2018 [29 ]b RC/propensity score matching 1014 15 and above Degenerative, deformity, trauma, neoplastics/posterior instrumentation Vancomycin powder 1–2 g 1.58% (8/507) 1.78% (9/507) Kim et al. 2013 [30 ] RC/logistic regression, multivariate analysis, and cox regression 74 NR Spinal instability/posterior instrumented fusion Vancomycin powder 1 g 0% (0/34) 12.5% (5/40, 3 deep, 2 superficial) Kunakornsawat et al. 2019 [31 ]‡ RCT/randomizations 400 11–82 Trauma, degenerative, congenital, neoplastic, infectious/posterior instrumented thoracic or lumbosacral fusions Vancomycin powder 1–2 g 3.40% (9/265) 2.96% (4/135) Lemans et al. 2017 [32 ] RC/NR 505 Adults Open posterior instrumentation Vancomycin powder 1–2 g 4.44% (8/180, 5 deep, 3 superficial) 13.85% (45/325, 31 deep, 14 superficial) Liu et al. 2015 [33 ]‡ RC/NR 334 53.5–74 Deformity, degenerative, neoplastic/posterior instrumentation Vancomycin powder 0.5–2 g 2.78% (5/180) 7.14% (11/154) Ludwig do nascimento et al. 2020 [34 ] RCT/randomization, double blinding 96 17–74 Degenerative, trauma/thoracolumbar spine arthrodesis 20 ml of saline with 2 g of diluted vancomycin 8.16% (4/49) 8.51% (4/47) Martin et al. 2014 [35 ]b,‡ RC/logistic regression, propensity score matching 306 18 and above Deformity/posterior instrumented fusion Vancomycin powder 2 g 5.12% (8/156) 5.33% (8/150) Ogihara et al. 2021 [36 ]‡ RC/multivariable analysis 2913 18–93 Degenerative/posterior instrumented fusion in the thoracic/lumbar spines Vancomycin powder 1.52% (7/460) 1.14% (28/2453) Oktay et al. 2020 [37 ] RC/NR 209 14–90 Degenerative, trauma, neoplastic, revision/posterior instrumentation Vancomycin powder 1 g 1.96% (2/102, 1 deep, 1 superficial) 6.54% (7/107, 4 deep, 3 superficial) O’Neill et al. 2011 [38 ] RC/pseudo-randomization 110 18 and above Trauma/posterior instrumented fusion Vancomycin powder 1 g 0% (0/56) 12.96% (7/54, 5 deep, 2 superficial) Satake et al. 2015 [39 ]‡, PC/NR 207 Not given Open posterior instrumented thoracic, lumbar fusion Vancomycin powder with fibrin glue (dosage NR) 0% (0/59) 6.08% (9/148) Scheverin et al. 2015 [40 ] RC/pseudo-randomization 513 18–78 Degenerative/posterior instrumented lumbar fusion Vancomycin powder 1 g mixed with bone graft 1.29% (3/232) 4.98% (14/281) Strom et al. 2013 [41 ] RC/NR 171 Adult patients Degenerative, infectious, neoplastic, trauma/posterior cervical instrumented fusion Vancomycin powder 1 g 2.53% (2/79) 10.87% (10/92) Strom et al. 2013 [42 ] RC/stratification 165 NRs Degenerative, infectious, neoplastic, trauma/lumbar laminectomy and posterior instrumented fusion Vancomycin powder 1 g 0% (0/88) 11.69% (9/77) Suh et al. 2015 [43 ] RCT/NR 86 23–83 Degenerative/posterior instrumented lumbar fusion Vancomycin powder 2 g 4.65% (2/43) 2.33% (1/43) Sweet et al. 2011 [44 ]‡, RC/NR 1732 12–86 Posterior instrumented thoracolumbar fusions Vancomycin powder 2 g 0.22% (2/911) 2.56% (21/821) Takeuchi et al. 2018 [45 ]d RCT/randomization, blinding 230 NR Deformity, degenerative, trauma/thoracic, lumbar fusion Vancomycin powder 1 g 1.72% (2/116, 1 deep, 1 superficial) 2.63% (3/114, 1 deep, 2 superficial) Takeuchi et al. 2019 [46 ] RC/NR 668 16–89 Degenerative, fracture/posterior spinal instrumentation Vancomycin powder 1 g 0.32% (1/314) 2.54% (9/354) Theologis et al. 2014 [47 ] RC/NR 215 18–88 Deformity/fusion greater than 3 levels Vancomycin powder 2 g 2.65% (4/151) 10.93% (7/64) Tofuku et al. 2012 [48 ]‡, RC/NR 384 7–89 Degenerative, neoplastic, trauma, infectious/spinal instrumentation 0.5 g Vancomycin-impregnated fibrin sealant 0% (0/196) 5.85% (11/188) Tubaki et al. 2013 [49 ]‡ RCT/randomization 606 3–84 Listhesis, disc prolapse/open instrumentation Vancomycin powder 1 g 1.99% (6/302) 1.97% (6/304)