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J Minim Invasive Spine Surg Tech > Accepted Articles
Is closed-suction drainage essential after minimally invasive lumbar fusion surgery? : A retrospective review of 381 cases
Arvind Gopalrao Kulkarni, Ravish Shammi Patel
Mumbai Spine Scoliosis & Disc Replacement Centre, Mumbai, India
Correspondence :  Arvind Gopalrao Kulkarni ,Tel: +91-9892875490, Fax: +91-22-22080871, Email: drarvindspines@gmail.com
Received: February 2, 2017  Revised: May 5, 2017   Accepted: May 8, 2017
Abstract
Purpose:
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: 150-348minutes) per level, mean blood loss was 125 ml per level (range: 80-190ml) and mean hospital stay was 5 days (range: 4-14days). 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%.
Conclusions:
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.
KeyWords: Spine; Lumbar; Arthrodesis; Minimally invasive surgical procedures; Complications; Epidural hematoma
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