Are Drains Useful for Lumbar Disc Surgery?

Mirzai, Hasan; Eminoğlu, M. Emin; Örgüç, Şebnem

doi:10.1097/01.bsd.0000190560.20872.a7

Cited by 111 publications

(68 citation statements)

References 21 publications

(14 reference statements)

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“…Suction drainage can be expected to help obviate the complication in case of certain amount of intraoperative bleeding; however, a multitude of previous studies have shown that it is not a fail-safe way to prevent the catastrophic complication 3456789101112). There was only one prospective study that demonstrated the efficacy of suction drainage in reduction of remaining epidural hematoma 13). Therefore, we conjectured there must be some factors that hamper appropriate function of suction drains, which should also be recognized as the risk factors for POSEH.…”

Section: Discussionmentioning

confidence: 99%

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Ahn¹,

Shin²,

Kim³

et al. 2016

Clin Orthop Surg

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BackgroundPostoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability.MethodsThis was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15.ResultsThe remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application.ConclusionsWith a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

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Section: Discussionmentioning

confidence: 99%

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Ahn¹,

Shin²,

Kim³

et al. 2016

Clin Orthop Surg

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“…Postoperative epidural hematomas (EH) have been reported as “very frequent” when radiologic investigation of the postoperative lumbar spine is performed [1]. Postoperative lumbar epidural fibrosis (EF) is the formation of scar tissue over the dura mater following EH [123456789].…”

Section: Introductionmentioning

confidence: 99%

“…Postoperative lumbar epidural fibrosis (EF) is the formation of scar tissue over the dura mater following EH [123456789]. EHs on the first postoperative day of lumbar disc surgery were reported to occur as frequently as 86% after using magnetic resonance imaging (MRI) [9].…”

Section: Introductionmentioning

confidence: 99%

“…Little is known about what differentiates symptomatic and asymptomatic patients. The quoted incidence of postoperative symptomatic EH occurring after all spinal procedures requiring surgical intervention ranges from 1% to 2.9% [169]. MRI measurements of hematoma size or mass may correlate with postoperative symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…The evacuation of an EH is considered advisable in order to prevent both postoperative pain, infections, and EF [379]. CSD is believed to be effective in preventing these complications in spine surgery [1]. However, the current spine literature has not shown any advantage for the use of CSDs in EF [712].…”

Section: Introductionmentioning

confidence: 99%

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Closed Drainage versus Non-Drainage for Single-Level Lumbar Disc Surgery: Relationship between Epidural Hematoma and Fibrosis

Kotıl

2016

Asian Spine J

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Study DesignA prospective clinical series with prospectively collected data.PurposeThe efficacy of using closed suction drains (CSD) after single-level lumbar disc surgery was evaluated. Postoperative CSD are regularly fitted to prevent postoperative epidural hematomas (EH) after multilevel lumbar decompression, although it remains unclear whether CSD also reduces postoperative EH following single-level lumbar disc surgery.Overview of LiteratureFew articles have addressed the clinical outcome in patients with single-level lumbar disc disease who were treated by two different operative methods (with and without drainage).MethodsBetween 2012 and 2014, 115 patients with a single level discectomy underwent two surgical procedures: with CSD (group A, 60 cases) and without CSD (group B, 55 cases). There were no significant differences in age, sex, segment level, herniation type, or disease duration between the groups. Wound infection, EH, and epidural fibrosis (EF) were evaluated by magnetic resonance imaging. Pain intensity was evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI). Reduction in analgesic treatment and patient satisfaction were also recorded.ResultsThe overall rate of postoperative EH was 5% and 16.3% in group A and B, respectively, whereas the rate of postoperative EF was 11.6% in group A and 21.8% in group B. The postoperative VAS score was 0.32 (standard deviation [SD], 0.45) for group A and 2.62 (SD, 06.9) for group B, whereas ODI was 9.11 (SD, 0.68) and 8.23 (SD, 0.78) for group A and and group B, respectively, with no significant differences observed.ConclusionsIn patients operated on by unilateral, single-level lumbar disc surgery, the use of suction CSD into the operation site results in lower levels of EH and EF radiologically, thereby providing a better clinical outcome.

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Surgical interventions for lumbar disc prolapse

Gibson

Waddell

2007

Cochrane Database of Systematic Reviews

130

109

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Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).

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Are Drains Useful for Lumbar Disc Surgery?

Cited by 111 publications

References 21 publications

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Closed Drainage versus Non-Drainage for Single-Level Lumbar Disc Surgery: Relationship between Epidural Hematoma and Fibrosis

Surgical interventions for lumbar disc prolapse

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