Is wound drainage necessary after lumbar spinal fusion surgery?

BACKGROUND: Despite a lack of any evidence to support the utilization of closed-suction drainage after spinal surgery, it is a frequently utilized procedure.

MATERIAL/METHODS: A retrospective evaluation of eighty-five consecutive posterior lumbar fusions at a single level for degenerative disease was performed during the six-year period between March of 1996 and February 2002 by a single surgeon. No patient had a drain placed at the conclusion of the surgical procedure.

RESULTS: One patient developed a postoperative deep wound infection requiring debridements and intravenous antibiotics for six weeks. One patient developed a postoperative cellulitis that resolved with PO antibiotics. One patient who received intravenous Lovenox (Enoxaparin) for deep vein thrombosis prophylaxis in the immediate peri-operative period developed a hematoma that was surgically decompressed. No additional complications were noted. The results of this study compare favorably with similar well-matched historical controls using routine peri-operative lumbar wound drainage.

CONCLUSIONS: Lumbar spinal fusion for degenerative disease without closed suction drainage in the immediate post-op period does not appear to increase the risks of wound related complications postoperatively as compared to historical controls. The routine use of postoperative closed-suction drainage following a single level posterior lumbar fusion for degenerative disease is not supported by the currently available literature. Such a conclusion is not applicable in nondegenerative pathologies such as metastatic disease following radiation where the risk of bleeding and wound complications may be much greater. In addition, individual patient subgroups with degenerative disease, such as those at risk for perioperative epidural bleeding, may benefit from the placement of a perisurgical drain.