Background: Although many surgeons stopped using closed-suction drainage following simple spine decompression surgery, there is still debate regarding the necessity of wound drainage in more extensive lumbar spine surgical procedures.
Purpose: To estimate the advantages and disadvantages of performing one- or two-level transforaminal lumbar interbody fusion (TLIF) without closed-suction drainage.
Study design: Retrospective.
Patients and Methods: The Fast-Track technique was performed in 36 consecutive TLIF surgeries between January and September 2016 without using wound drainage. The results of these cases were retrospectively analyzed and reviewed with the results of 189 previous TLIF surgeries performed in our institution in which closed-suction wound drainage was used.
Results: No postoperative allogenic blood transfusion, no patients developed postoperative neurological deficit, and there were no cases of surgical revision as a result of significant postoperative hematoma or infection. There were two cases (5.5%) of revision surgery due to persistent CSF leakage from the wound. Four patients (11.1%) developed serous discharge from the wound, that was treated conservatively with frequent dressing. Four patients (11.1%) developed postoperative fever. The mean pain score in the first 2 days after surgery assessed by the visual analogue score (VAS) was 6.1 points, and additional opiate in the first 2 postoperative days was mandatory in 30 patients (83.3%).
On the contrary; in our previous 189 TLIF cases in which closed-suction wound drainage was used, the rate of revision surgery due to wound healing problems and infection was 3.7%, the rate of postoperative fever was 19%, additionally 4.2% of the patients received allogenic blood postoperative. However, in the first 2 postoperative days, the average pain score and the rate of additional opiate use were 4.8 and 73.5%.
Conclusion: Performing one or two-level lumbar decompression and fusion without closed-suction wound drainage did not increase the complication rate, nevertheless avoid using a drain may be associated with less allogenic blood transfusion, less postoperative fever and lower rate of infection. The disadvantage of avoid using a drain was more pain and hence higher opiate use in the first two postoperative days.
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