Study Background: Infection is a challenging complication in spinal surgery, with various
methods proposed to reduce intraoperative bacterial load and subsequently lower
postoperative infection rates. The use of iodine-containing solutions on surgical wounds
has been shown to effectively reduce infection rates after spinal surgery. However, some
studies suggest that iodine solutions may impair fibroblast activity, affecting wound
healing. Chlorhexidine is another effective antimicrobial agent, which, compared to
iodine solutions, has similar antimicrobial efficacy without hindering wound recovery.
Its use for intraoperative irrigation in joint replacement surgery has been reported to
effectively reduce postoperative infections. Yet, evidence of its effectiveness as an
irrigation solution in spine surgery is lacking, and previous studies have rarely focused
on intraoperative wound sampling to investigate whether irrigation solutions can
effectively reduce microbial residue.
Study Objective: The aim of this experiment is to evaluate whether the use of
iodine-containing solutions and chlorhexidine for wound irrigation before closing spinal
surgery wounds can effectively reduce the positive rate of bacterial cultures, and to
assess which has stronger functionality and any associated side effects.
Study Methods: This research will include patients diagnosed with lumbar spinal stenosis
causing nerve compression, who are scheduled for open spinal decompression and fusion
surgery. Patients will be randomly assigned to one of three groups: a control group
(soaked with 0.9% normal saline), an iodine group (soaked with 3.5% povidone-iodine
solution), and a CHG group (soaked with 0.05% chlorhexidine gluconate). All groups will
receive the same surgical pre-care, preoperative disinfection, and prophylactic
antibiotics. Before wound closure, each group will undergo different irrigation solutions
for soaking the wound for three minutes followed by rinsing with copious saline. Samples
from deep and superficial tissues and implants will be taken for bacterial culture and
molecular biochip analysis.
Study Significance: Infections in spinal surgery have a significant impact on patient
outcomes and healthcare costs. This study aims to confirm whether pre-wound closure
soaking with antimicrobial solutions can effectively reduce bacterial load inside and
outside the wound to lower the risk of postoperative infection.
