The Outcome of Posterior Spinal Fusion and Instrumentation of Adolescent Idiopathic Scoliosis without Wound Suction Drainage

Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.

Advantages of using a prophylactic epidural closed drain and non-watertight dura suture in a craniotomy near the“parietal site”

Background:In neurosurgery,the necessity of having a drainage tube is controversial.Subgaleal fluid collection(SFC)often occurs,especially in a craniotomy near the“parietal site”.This study aimed to reassess the benefit of using a prophylactic epidural drainage(ED)and non-watertight dura suture in a craniotomy near the parietal site.Methods:A retrospective review was conducted on 63 consecutive patients who underwent a craniotomy near the parietal site.The patients were divided into two groups according to different period.The deal group received ED and a non-watertight dura suture(drain group,DG),the control group that did not(non-drain group,NDG).Complications and patient recovery were evaluated and analysed.Results:Three patients(11.5%,26)in DG and 20 patients(54.1%,37)in NDG presented with SFC(p<0.05).One patient(3.8%)in DG and three patients(8.1%)in NDG presented with subdural tensile hydrops(STH)(p>0.05).Six developed an infection in NDG(four intracranial infections,one abscess,one pulmonary infection),while none in DG(p>0.05)developed infection.Three(11.5%)cases in DG and one(2.7%)case in NDG had muscle strength that improved postoperatively(p>0.05).Fifteen(57.7%)in DG and 14(37.8%)in NDG had epileptic seizures less frequently postoperatively(p<0.05).The average temperature(37.4°C vs 37.6°C,p>0.05),the maximum temperature(37.9°C vs 38.1°C,p>0.05)on 3 PODs,the postoperative hospital stay day(7.5 days vs 8.0 days,p>0.05),and the postoperative medicine fee(¥29762.0 vs¥28321.0,p>0.05)were analysed.Conclusion:In patients who undergo a craniotomy near the parietal site,the prophylactic use of ED and a nonwatertight dura suture helps reduce SFC,infection,and control epilepsy.