Background: Surgical site infection remains a significant complication following spinal surgery, particularly in patients treated for spondylodiscitis. The use of intrawound vancomycin powder has been proposed as a local preventive strategy, although its effectiveness remains uncertain.

Methods: A retrospective cohort study was conducted including adult patients who underwent posterior surgical debridement, with or without instrumentation, for spondylodiscitis between 2021 and 2023. Patients were divided into those receiving intrawound vancomycin and those who did not. The primary outcome was postoperative wound infection. Statistical analysis included Fisher’s exact test and multivariate logistic regression, with results reported as odds ratios (OR) and 95% confidence intervals (CI).

Results: Ninety patients were included (vancomycin: 55 [61.1%]; control: 35 [38.9%]). Postoperative wound infection occurred less frequently in the vancomycin group (9.1% vs 14.3%). On multivariate analysis, intrawound vancomycin use was associated with reduced odds of infection (OR 0.49, 95% CI 0.11–2.24). Diabetes mellitus was identified as a significant risk factor.

Conclusion: Intrawound vancomycin use was associated with a lower observed rate of postoperative infection despite being applied in more complex cases. Although statistical significance was not reached, the direction and magnitude of effect suggest a potential clinical benefit. Larger prospective studies are required to confirm these findings.