Is Closed-suction Drainage Necessary for Single-level Lumbar Decompression?: Review of 560 Cases

Kanayama, Masahiro; Oha, Fumihiro; Togawa, Daisuke; Shigenobu, Keiichi; Hashimoto, Tomoyuki

doi:10.1007/s11999-010-1235-6

Cited by 100 publications

(94 citation statements)

References 13 publications

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“…In our series, we did not experience such hematoma, but post-surgical epidural hematoma for 1 case (1%), which is common in the traditional spine surgery. The incidence of postoperative symptomatic epidural hematoma occurring after all spinal procedures requiring surgical intervention ranges from 0.2% to 2.9% (14). The incidence in our series was not very high as comparing to the previous reports.…”

Section: Discussioncontrasting

confidence: 52%

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

et al. 2014

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: The minimally invasive percutaneous endoscopic discectomy (PED) as the postero-lateral approach with the local anesthesia was started in the late 20th century. The procedure only requires 8 mm of skin incision ; thus, it is the least invasive disc surgery presently. The surgery related complications were reviewed in the initial 100 cases from the single surgeon (K.S., first author). Two cases showed exiting nerve irritation, and complained of leg paresthetic pain for 6 to 12 weeks after the surgery (2.0% %). The symptoms got better with medicines. One showed post-surgical epidural hematoma, and required surgical removal of the mass (1.0% %). Two cases complained neck pain during surgery (2.0% %). Surgeons would be aware of the specific complications for the postero-lateral approach of PED procedure. J. Med. Invest. 61 : 264-269, August, 2014

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Section: Discussioncontrasting

confidence: 52%

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

et al. 2014

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“…The incidence of SSI was not different between groups (1.9% vs. 1.0%). In contrast to the study of Kanayama et al [83], no patients developed neurologic deficits or hematomas of clinical importance in this series.…”

Section: Spine Surgerycontrasting

confidence: 99%

“…Kanayama et al [83] performed a retrospective review of 560 consecutive patients who underwent single-level lumbar laminectomy to examine the effect of prophylactic drain placement on the rates of SSI and epidural hematoma. During the first two years of the five-year study, all patients received CSDs, and no patients received drains thereafter.…”

Section: Spine Surgerymentioning

confidence: 99%

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Reiffel

Barie

Spector

2013

Surgical Infections

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Background: Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods: The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results: Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions: Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to ''cover'' an indwelling drain.

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“…Though we used suction drains to prevent EH, it didn't work. According to the previous reports, the effect of a suction drain is very untrustworthy, 14,[20][21][22][23][24][25] Fig. 3.…”

Section: Discussionmentioning

confidence: 91%

Neurological Complications of Posterior Spinal Surgery: Incidence and Clinical Features

Ahn¹,

Lee²,

Shin³

et al. 2018

J Korean Soc Spine Surg

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Study design: Retrospective study. Objectives: To identify clinical features and risk factors helpful for the prevention and early diagnosis of neurological complications. Overview of Literature: Previous studies have investigated postoperative complications only for specific disease entities and did not present distinctive clinical features. Materials and Methods: This was an observational study of patients who underwent posterior thoracolumbar spinal surgery in the orthopedic department of a single hospital over the course of 19 years (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). The incidence, cause, onset time, and risk factors of complications were investigated. Neurological deterioration was graded on a 5-point numeric scale: G1, increased leg pain or sensory loss, G2, unilateral motor weakness; G3, bilateral motor weakness; G4, cauda equina syndrome; and G5, complete paraplegia. Results: Sixty-five cases out of 6574 (0.989%) developed neurological complications due to the following causes: epidural hematoma, 0.380%; instrumentation with inadequate decompression, 0.213%; mechanical injury, 0.167%; inadequate discectomy, 0.061%; and unknown cause, 0.167% (p=0.000). The grade of neurological deterioration was G1 in 0.167% of patients, G2 in 0.517%, G3 in 0.228%, G4 in 0.046%, and G5 in 0.030%. Neurological deterioration was most severe in patients who experienced epidural hematoma, followed by those in whom complications occurred due to instrumentation with inadequate decompression, unknown causes, mechanical injury, and inadequate discectomy, in order (p=0.009). Revision surgery was a significant risk factor (p=0.000; odds ratio, 2.741). The time that elapsed until symptom development was as follows, in order: unknown cause, 0.6 hours; epidural hematoma, 5.4 hours; mechanical injury, 6.6 hours; inadequate discectomy, 18.0 hours; and instrumentation with insufficient decompression, 36.0 hours (p=0.001). Conclusions:The incidence of neurological complications in our cohort was 1%. Revision surgery increased the risk by 3 times. Severe cases (cauda equina syndrome or complete paraplegia) rarely developed, occurring in 0.08% of patients. The major causes of neurological decline were epidural hematoma and instrumentation with inadequate decompression. Close observation in the early period was important for the diagnosis because most patients developed symptoms within 12 hours. Delayed diagnosis was most common in complications caused by instrumentation with inadequate decompression.

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Is Closed-suction Drainage Necessary for Single-level Lumbar Decompression?: Review of 560 Cases

Cited by 100 publications

References 13 publications

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Neurological Complications of Posterior Spinal Surgery: Incidence and Clinical Features

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