Negative versus natural drainage after single-level posterior lumbar interbody fusion. A prospective randomized study

Tarek Elfiky; Ramy Shehata; Mahmoud Nafady

doi:10.1016/j.bas.2022.101709

Negative versus natural drainage after single-level posterior lumbar interbody fusion. A prospective randomized study

Brain Spine. 2022 Dec 23:3:101709. doi: 10.1016/j.bas.2022.101709. eCollection 2023.

Authors

Tarek Elfiky¹, Ramy Shehata², Mahmoud Nafady¹

Affiliations

¹ Spine Unit, Orthopedic Department, Elhadra University Hospital, Amprozo, Alexandria, Egypt.
² Addenbrooke's- Cambridge University Hospital, King's College NHS Trust, UK.

Abstract

Introduction: Despite of their extensive use, drains remain controversial without clear guidelines, and there is unclear evidence on drain use in spine procedures. Negative pressure drainage is theoretically more effective in preventing postoperative hematomas. On the contrary, it may result in excessive drainage and blood loss.The aim of this study was to compare the outcome between the uses of negative versus natural drainage in single level posterior lumbar interbody fusion (PLIF).

Research question: The aim is to compare between negative versus natural drainage after single-level PLIF as regard to postoperative wound infection, wound healing, temperature, pain and neurological deficits.

Materials and methods: A prospective randomized study of consecutive PLIF patients at a single level for lumbar disc prolapse was performed between January 2019 and January 2020. The patients were randomly assigned to either the negative suction drainage group or natural drainage group. Negative suction was created by maximum compression of the reservoir to create negative pressure. In the other group, natural pressure drainage was kept without any negative pressure.Our study included a total of 62 patients who met the inclusion criteria. They were divided into two groups; 33 patients had negative suction drains and 29 patients had natural drainage. There were 32 female (51.6%) and 30 male (48.4%). Their ages ranged between of 23-69 years, with a mean age of 42.11 ± 8.89 years.

Results: Drainage volume was statistically higher in the negative group on the day of surgery (day 0) as well as the 1st and second days after. However, no significant differences were observed as regards to postoperative temperature, pain, wound infection, temperature, or neurological deficits.

Discussion &conclusion: In this prospective randomized study, our results revealed that natural drainage in short term can reduce the total amount of blood in the drain, and therefore the blood loss without significant differences in postoperative wound infection, wound healing, temperature, pain, or neurological deficits in single-level PLIF.

Keywords: Drain; Natural drainage; Negative; PLIF; Single.