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Archives of Orthopaedic and Trauma Surgery

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02-06-2023 | Epidural Hematoma | Orthopaedic Surgery

Natural pressure drainage versus negative pressure drainage following transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degeneration disease: a prospective cohort study

Authors: Fengxian Jiang, Han Wu, Mengyang Pu, Yixin Shen, Peng Zhang, Wentao Zhong

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2023

Abstract

Objective

To comprehensively compare the perioperative data and clinical outcomes of natural pressure drainage (NAPD) and negative pressure drainage (NEPD) following transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degeneration disease.

Methods

Between January 2021 and December 2021, 203 patients in our hospital who underwent single- or two-segment TLIF were assigned to the NAPD group (112 patients) or the NEPD group (91 patients) based on different postoperative drainage methods. Between the two groups, comparisons were made regarding the demographics, intraoperative and postoperative data, patient-reported outcomes, and complications.

Results

The NAPD group experienced less overall drainage and fewer postoperative drainage days (157.89 vs. 318.49 ml/249.54 vs. 589.43 ml, 2.00 vs. 2.67 days/2.04 vs. 2.74 days, P < 0.001) than the NEPD group. The NAPD group has a higher rate of overall hidden blood loss (HBL) than the NEPD group (63.98% vs. 51.90%/65.80% vs. 48.11%, P < 0.001); HBL, however, did not significantly differ between the two groups (P > 0.05). In two-segment surgery, the postoperative hemoglobin (HGB) levels were higher in the NAPD group (99.67 vs. 92.69 g/L, P < 0.05), but there was no difference in single-segment surgery (P > 0.05). Regardless of whether single- or two-segment surgery was performed, the NAPD group had a lower HGB level loss (18.81% vs. 21.63%/26.35% vs. 32.08%, P < 0.05). There was no discernible difference between the two groups in the visual analog scale (VAS) scores for symptomatic epidural hematoma, postoperative body temperature, low back and leg pain, or incision infection (P > 0.05).

Conclusion

NAPD did not increase postoperative complications but did significantly reduce postoperative drainage volume and the risk of anemia. We show that, when compared to NEPD, NAPD may be a better option for patients following TLIF.

Zhou W, Li LJ, Tan J (2010) Treatment of degenerative lumbar spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery. Zhongguo Gu Shang 23(4):251–253PubMed

Griessenauer CJ, Raborn J, Foreman P, Shoja MM, Loukas M, Tubbs RS (2015) Venous drainage of the spine and spinal cord: a comprehensive review of its history, embryology, anatomy, physiology, and pathology. Clin Anat 28(1):75–87. https://doi.org/10.1002/ca.22354CrossRefPubMed

Herrick DB, Tanenbaum JE, Mankarious M, Vallabh S, Fleischman E, Kurra S, Burke SM, Roguski M, Mroz TE, Lavelle WF, Florman JE, Riesenburger RI (2018) The relationship between surgical site drains and reoperation for wound-related complications following posterior cervical spine surgery: a multicenter retrospective study. J Neurosurg Spine 29(6):628–634. https://doi.org/10.3171/2018.5.SPINE171313CrossRefPubMed

Kotil K (2016) Closed drainage versus non-drainage for single-level lumbar disc surgery: relationship between epidural hematoma and fibrosis. Asian Spine J 10(6):1072–1078. https://doi.org/10.4184/asj.2016.10.6.1072CrossRefPubMedPubMedCentral

Mirzai H, Eminoglu M, Orguc S (2006) Are drains useful for lumbar disc surgery? A prospective, randomized clinical study. J Spinal Disord Tech 19(3):171–177. https://doi.org/10.1097/01.bsd.0000190560.20872.a7CrossRefPubMed

Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232PubMed

Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58(3):277–280. https://doi.org/10.1097/00000542-198303000-00016CrossRefPubMed

Heller GZ, Manuguerra M, Chow R (2016) How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain 13:67–75. https://doi.org/10.1016/j.sjpain.2016.06.012CrossRefPubMed

Huang Y, Yin J, Sun Z, Song S, Zhuang Y, Liu X, Du S, Rui Y (2020) Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: a meta-analysis. Orthopade 49(4):338–349. https://doi.org/10.1007/s00132-019-03710-zCrossRefPubMed

10.

von Eckardstein KL, Dohmes JE, Rohde V (2016) Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire. Eur Spine J 25(3):708–715. https://doi.org/10.1007/s00586-015-3790-8CrossRef

11.

Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7(3):151–155. https://doi.org/10.1016/s0968-0160(00)00047-8CrossRefPubMed

12.

Smorgick Y, Baker KC, Bachison CC, Herkowitz HN, Montgomery DM, Fischgrund JS (2013) Hidden blood loss during posterior spine fusion surgery. Spine J 13(8):877–881. https://doi.org/10.1016/j.spinee.2013.02.008CrossRefPubMed

13.

Yang Y, Zhang L, Liu B, Pang M, Xie P, Chen Z, Wu W, Feng F, Rong L (2017) Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion. J Orthop Traumatol 18(4):395–400. https://doi.org/10.1007/s10195-017-0464-9CrossRefPubMedPubMedCentral

14.

Zhang H, Chen ZX, Sun ZM, Jiang C, Ni WF, Lin Y, Wu YS (2017) Comparison of the total and hidden blood loss in patients undergoing open and minimally invasive transforaminal lumbar interbody fusion. World Neurosurg 107:739–743. https://doi.org/10.1016/j.wneu.2017.08.113CrossRefPubMed

15.

Lei F, Li Z, He W, Tian X, Zheng L, Kang J, Feng D (2020) Hidden blood loss and the risk factors after posterior lumbar fusion surgery: a retrospective study. Med (Baltim) 99(19):e20103. https://doi.org/10.1097/MD.0000000000020103CrossRef

16.

Su QH, Zhu K, Li YC, Chen T, Zhang Y, Tan J, Guo S (2020) Choice and management of negative pressure drainage in anterior cervical surgery. World J Clin Cases 8(11):2201–2209. https://doi.org/10.12998/wjcc.v8.i11.2201CrossRefPubMedPubMedCentral

17.

Bertalanffy H, Eggert HR (1989) Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 99(1–2):41–50. https://doi.org/10.1007/BF01407775CrossRefPubMed

18.

Walid MS, Abbara M, Tolaymat A, Davis JR, Waits KD, Robinson JS 3rd, Robinson JS Jr (2012) The role of drains in lumbar spine fusion. World Neurosurg 77(3–4):564–568. https://doi.org/10.1016/j.wneu.2011.05.058CrossRefPubMed

19.

Lo Bianco S, Cavallaro D, Okatyeva V, Buffone A, Cannizzaro MA (2015) Thyroidectomy: natural drainage or negative drainage? Experience with randomized single-center study. Ann Ital Chir 86(3):267–272PubMed

20.

Woo SH, Kim JP, Park JJ, Shim HS, Lee SH, Lee HJ, Won SJ, Son HY, Kim RB, Son YI (2013) Comparison of natural drainage group and negative drainage groups after total thyroidectomy: prospective randomized controlled study. Yonsei Med J 54(1):204–208. https://doi.org/10.3349/ymj.2013.54.1.204CrossRefPubMed

21.

Miao K, Ni S, Zhou X, Xu N, Sun R, Zhuang C, Wang Y (2015) Hidden blood loss and its influential factors after total hip arthroplasty. J Orthop Surg Res 10:36. https://doi.org/10.1186/s13018-015-0185-9CrossRefPubMedPubMedCentral

22.

Faris PM, Ritter MA, Keating EM, Valeri CR (1991) Unwashed filtered shed blood collected after knee and hip arthroplasties. A source of autologous red blood cells. J Bone Joint Surg Am 73(10):1580

23.

Erskine JG, Fraser C, Simpson R, Protheroe K, Walker ID (1981) Blood loss with knee joint replacement. J R Coll Surg Edinb 26(5):295–297PubMed

24.

Chen T, Chang H, Liu K, Shi M, Song C, Meng X (2020) Drainage after posterior single-level instrumented lumbar fusion: natural pressure vs negative pressure. Med (Baltim) 99(7):e19154. https://doi.org/10.1097/MD.0000000000019154CrossRef

25.

Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E (2002) Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 20(3):506–515. https://doi.org/10.1016/S0736-0266(01)00153-XCrossRefPubMed

26.

Pennington Z, Lubelski D, Molina C, Westbroek EM, Ahmed AK, Sciubba DM (2019) Prolonged post-surgical drain retention increases risk for deep wound infection after spine surgery. World Neurosurg 130:e846–e853. https://doi.org/10.1016/j.wneu.2019.07.013CrossRefPubMed

27.

Rao SB, Vasquez G, Harrop J, Maltenfort M, Stein N, Kaliyadan G, Klibert F, Epstein R, Sharan A, Vaccaro A, Flomenberg P (2011) Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis 53(7):686–692. https://doi.org/10.1093/cid/cir506CrossRefPubMed

28.

Sankar B, Ray P, Rai J (2004) Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations. Int Orthop 28(5):311–314. https://doi.org/10.1007/s00264-004-0561-2CrossRefPubMedPubMedCentral

29.

Drinkwater CJ, Neil MJ (1995) Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty 10(2):185–189. https://doi.org/10.1016/s0883-5403(05)80125-1CrossRefPubMed

30.

Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine (Phila Pa 1976) 28(15 Suppl):S26–35. https://doi.org/10.1097/01.BRS.0000076895.52418.5E

31.

Liu H, Li J, Sun Y, Wang X, Wang W, Guo L, Zhang F, Zhang P, Zhang W (2022) A Comparative study of a new retractor-assisted WILTSE TLIF, MIS-TLIF, and traditional PLIF for treatment of single-level lumbar degenerative diseases. Orthop Surg 14(7):1317–1330. https://doi.org/10.1111/os.13289CrossRefPubMedPubMedCentral

32.

Ali EMS, El-Hewala TA, Eladawy AM, Sheta RA (2022) Does minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) influence functional outcomes and spinopelvic parameters in isthmic spondylolisthesis? J Orthop Surg Res 17(1):272. https://doi.org/10.1186/s13018-022-03144-yCrossRefPubMedPubMedCentral

33.

Modi HN, Shrestha U (2021) Comparison of clinical outcome and radiologic parameters in open TLIF versus MIS-TLIF in single- or double-level lumbar surgeries. Int J Spine Surg 15(5):962–970. https://doi.org/10.14444/8126

34.

Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F (2019) Open versus minimally invasive TLIF: literature review and meta-analysis. J Orthop Surg Res 14(1):229. https://doi.org/10.1186/s13018-019-1266-yCrossRefPubMedPubMedCentral

35.

Le H, Anderson R, Phan E, Wick J, Barber J, Roberto R, Klineberg E, Javidan Y (2021) Clinical and radiographic comparison between open versus minimally invasive transforaminal lumbar interbody fusion with bilateral facetectomies. Global Spine J 11(6):903–910. https://doi.org/10.1177/2192568220932879CrossRefPubMed

36.

Hung PI, Chang MC, Chou PH, Lin HH, Wang ST, Liu CL (2017) Is a drain tube necessary for minimally invasive lumbar spine fusion surgery? Eur Spine J 26(3):733–737. https://doi.org/10.1007/s00586-016-4672-4CrossRefPubMed

Title: Natural pressure drainage versus negative pressure drainage following transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degeneration disease: a prospective cohort study
Authors: Fengxian Jiang
Han Wu
Mengyang Pu
Yixin Shen
Peng Zhang
Wentao Zhong
Publication date: 02-06-2023
Publisher: Springer Berlin Heidelberg
Keywords: Epidural Hematoma
Incision
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-04937-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Natural pressure drainage versus negative pressure drainage following transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degeneration disease: a prospective cohort study

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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