J Minim Invasive Spine Surg Tech.  2017 Jun;2(1):27-31. 10.21182/jmisst.2017.00185.

Is Closed-Suction Drainage Essential after Minimally Invasive Lumbar Fusion Surgery?: A Retrospective Review of 381 Cases

• Kulkarni AG
• Patel RS

• KMID: 2562022
• DOI: http://doi.org/10.21182/jmisst.2017.00185

Abstract

Objective
Closed suction drains have been widely used after lumbar fusion surgeries but with controversial evidence. The recent advances in the minimally invasive spine surgeries (MIS) lead to smaller dead space, lesser blood loss and fewer infections. With these touted advantages the drains may not be necessary. Our study was aimed to evaluate the outcomes of MIS lumbar fusions without closed-suction drains. Methods: A retrospective review was conducted between June 2007 and January 2016. Patients that underwent MIS transforaminal lumbar interbody fusion (TLIFs) without postoperative drainage were enrolled. Patients with more than 12 months of follow-up were selected. Perioperative variables and clinical outcomes were analysed from the medical records. Incidences of infection and postoperative epidural hematoma were evaluated. Results: Out of 381 patients, there were 341 patients that underwent one-level fusion and 40 patients had two-level fusions. The mean operative time was 218 minutes (range: 150-348 minutes) per level, mean blood loss was 125 mL per level (range: 80-190 mL) and mean hospital stay was 5 days (range: 4-14 days). Visual Analogue Scale (VAS) leg, VAS back and Oswestry Disability Index (ODI) scores improved by 70.6%, 58.6% and 57.4% respectively. Three patients had infections and one patient developed postoperative epidural hematoma requiring surgical intervention. The infection rate was 0.78% and the incidence of postoperative epidural hematoma with the neurological deficit was 0.26%. Conclusion: MIS-TLIFs without a postoperative closed-suction drain showed favourable outcomes. There was no evidence of an increase in the rate of infection or increase in rate of symptomatic postoperative epidural hematoma in patients undergoing MIS-TILFs without a postoperative closed-suction drain.

Keyword

Spine; Lumbar; Arthrodesis; Minimally Invasive Surgical Procedures; Complications; Infections; Epidural hematoma