Effect of Cyanoacrylate Microbial Sealant on Intraoperative Bacterial Contamination in Spine Surgery: A Prospective Consecutive Study

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.