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Are drains useful for lumbar disc surgery? A prospective, randomized clinical study
Hasan Mirzai1, Mehmet Eminoglu, Sebnem Orguc
1Department of Neurosurgery, Celal Bayar University, School of Medicine, Manisa, Turkey. hmirzai@yahoo.com
Journal of Spinal Disorders & Techniques
|June 14, 2006
Summary
Inserting an epidural drain after lumbar disc surgery significantly reduces the occurrence and size of postoperative hematomas. This may help prevent epidural fibrosis and improve surgical outcomes.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Postoperative epidural hematoma is a common complication after lumbar disc surgery.
- Epidural hematoma is a suspected cause of epidural fibrosis, potentially leading to poor surgical outcomes.
Purpose of the Study:
- To investigate the efficacy of epidural drain insertion in reducing the incidence and size of postoperative epidural hematoma.
- To assess the impact of drain insertion on the development of epidural fibrosis and clinical outcomes.
Main Methods:
- A prospective, observer-masked study involving 50 patients undergoing lumbar disc surgery.
- Patients were randomized into two groups: with or without an epidural drain.
- Postoperative epidural hematoma was assessed using MRI on day 1, and epidural fibrosis at 6 months. Clinical outcomes were evaluated using the Oswestry Disability Index.
Main Results:
- Epidural hematoma was detected in 36% of patients with a drain versus 89% without (P=0.000).
- The incidence and size of hematomas were significantly lower in the drain group (P=0.000).
- Epidural fibrosis occurred in 31.6% of patients with a drain compared to 58.3% without (P=0.08).
Conclusions:
- Epidural drain insertion effectively reduces postoperative epidural hematoma after lumbar disc surgery.
- Drainage may play a role in preventing epidural fibrosis and improving surgical outcomes, although further research is needed to confirm statistical significance in clinical results.