Drainage versus Nondrainage for Thoracolumbar Spine Surgery: An Evidence Synthesis

Objective

Drainage tube placement during posterior thoracolumbar spine surgery is common, yet debated due to conflicting evidence on complication risks. This study compares the safety and efficacy of drainage use versus nonuse.

Methods

A systematic review of PubMed, EMBASE, and Cochrane databases identified randomized controlled trials using terms like “Drainage,” “Spine,” and “randomized controlled trial.” Two reviewers independently screened studies, assessed bias, and extracted data on outcomes including surgical site infection (SSI), postoperative epidural hematomas (PEHs), reoperation, transfusions, dressing changes, Oswestry Disability Index, and visual analog scale. Subgroup analyses and Grading of Recommendations, Assessment, Development, and Evaluation evaluation were performed.

Results

A total of 11 randomized control trials met the inclusion criteria. Drainage use correlated with significantly lower PEH incidence (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.03–0.40), reduced postoperative fever (OR 0.62, 95% CI 0.39–0.97), and fewer dressing changes (OR 0.33, 95% CI 0.13–0.79) in single-segment surgeries. However, in multisegment procedures, drainage was associated with higher transfusion risk (OR 2.88, 95% CI 1.13–7.32). No significant differences were observed in SSI (OR 0.95, 95% CI 0.42–2.16), reoperation (OR 0.88, 95% CI 0.28–2.83), hospital stay, Oswestry Disability Index, or visual analog scale between groups.

Conclusions

The utilization of drainage tubes in posterior thoracolumbar spine surgery does not show significant associations with SSI, reoperation rates, length of hospital stay, or clinical effectiveness. However, their use is associated with an increased frequency of postoperative blood transfusions. In single-segment operations, drainage tube placement demonstrates correlations with a lower occurrence of PEH, reduced probability of postoperative fever, and fewer dressing changes.