Is Closed-Suction Drainage Essential after Minimally Invasive Lumbar Fusion Surgery?: A Retrospective Review of 381 Cases

Objective Closed suction drains have been widely used after lumbar fusion surgeries but with controversial evidence. The recent advances in the minimally invasive spine surgeries (MIS) lead to smaller dead space, lesser blood loss and fewer infections. With these touted advantages the drains may not be necessary. Our study was aimed to evaluate the outcomes of MIS lumbar fusions without closed-suction drains. Methods A retrospective review was conducted between June 2007 and January 2016. Patients that underwent MIS transforaminal lumbar interbody fusion (TLIFs) without postoperative drainage were enrolled. Patients with more than 12 months of follow-up were selected. Perioperative variables and clinical outcomes were analysed from the medical records. Incidences of infection and postoperative epidural hematoma were evaluated. Results Out of 381 patients, there were 341 patients that underwent one-level fusion and 40 patients had two-level fusions. The mean operative time was 218 minutes (range: 150-348 minutes) per level, mean blood loss was 125 mL per level (range: 80-190 mL) and mean hospital stay was 5 days (range: 4-14 days). Visual Analogue Scale (VAS) leg, VAS back and Oswestry Disability Index (ODI) scores improved by 70.6%, 58.6% and 57.4% respectively. Three patients had infections and one patient developed postoperative epidural hematoma requiring surgical intervention. The infection rate was 0.78% and the incidence of postoperative epidural hematoma with the neurological deficit was 0.26%. Conclusion MIS-TLIFs without a postoperative closed-suction drain showed favourable outcomes. There was no evidence of an increase in the rate of infection or increase in rate of symptomatic postoperative epidural hematoma in patients undergoing MIS-TILFs without a postoperative closed-suction drain

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

Study DesignRetrospective review of prospectively collected data.PurposeTo evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI.Overview of LiteratureSSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications.MethodsAll patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI.ResultsA total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS.ConclusionsOverall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs

Current Status of the Use of Salvaged Blood in Metastatic Spine Tumour Surgery

To review the current status of salvaged blood transfusion (SBT) in metastatic spine tumour surgery (MSTS), with regard to its safety and efficacy, contraindications, and adverse effects. We also aimed to establish that the safety and adverse event profile of SBT is comparable and at least equal to that of allogeneic blood transfusion. MEDLINE and Scopus were used to search for relevant articles, based on keywords such as “cancer surgery,” “salvaged blood,” and “circulating tumor cells.” We found 159 articles, of which 55 were relevant; 20 of those were excluded because they used other blood conservation techniques in addition to cell salvage. Five articles were manually selected from reference lists. In total, 40 articles were reviewed. There is sufficient evidence of the clinical safety of using salvaged blood in oncological surgery. SBT decreases the risk of postoperative infections and tumour recurrence. However, there are some limitations regarding its clinical applications, as it cannot be employed in cases of sepsis. In this review, we established that earlier studies supported the use of salvaged blood from a cell saver in conjunction with a leukocyte depletion filter (LDF). Furthermore, we highlight the recent emergence of sufficient evidence supporting the use of intraoperative cell salvage without an LDF in MSTS