Gravity-drain versus closed-suction subfascial drainage following lumbar decompression and fusion

Subfascial drainage is commonly used following lumbar laminectomy and fusion to reduce postoperative hematoma and wound-related complications. While closed-suction drainage is traditionally employed, concerns exist regarding increased blood loss and prolonged drain output. Gravity off suction drainage represents an alternative approach; however, data comparing its safety and efficacy to closed-suction systems in lumbar spine surgery are limited. The purpose of this study was to evaluate the efficacy and safety of gravity off suction subfascial drainage in lumbar laminectomy and fusion cases.

A retrospective review was performed of lumbar procedures by four surgeons at a single institution from March 2018 through December 2020 in a tertiary care, community teaching hospital. Elective posterior-only lumbar laminectomy and fusion procedures were included. Cervical and thoracic cases, cases undergoing osteotomy, and minimally invasive lumbar cases were excluded from the study. A total of 196 patients were included in the study (100 in the gravity-drain group and 96 in the closed-suction group).

Significantly fewer patients in the gravity-drain group (38%) needed a blood transfusion vs. the closed-suction group (63%, P=0.001), and drain output was significantly lower in the gravity-drain group vs. the closed-suction group (350 vs. 499 mL, respectively, P=0.01). There were no occurrences of postoperative symptomatic spinal epidural hematoma (SEH) in the gravity-drain group, and one patient in the closed-suction group developed a compressive hematoma requiring evacuation.

This study demonstrated that, after elective lumbar laminectomy and fusion surgery, gravity drainage resulted in lower transfusion rates and drain output when compared to closed-suction drainage. These findings suggest that use of gravity drainage decreases the risk of postoperative blood loss and blood transfusion requirements without increasing the risk of symptomatic epidural hematoma after posterior lumbar fusion.