Aims

Closed suction subfascial drainage is widely used after instrumented posterior spinal fusion in patients with a spinal deformity. The aim of this study was to determine the effect of this wound drainage on the outcomes in patients with adolescent idiopathic scoliosis (AIS). This was a further analysis of a randomized, multicentre clinical trial reporting on patients after posterior spinal fusion using segmental pedicle screw instrumentation. In this study the incidence of deep surgical site infection (SSI) and chronic postoperative pain at two years’ follow-up are reported.

Aims. The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Methods. Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications. Results. All 90 patients were included in the primary outcome analysis (no drain = 43; drain = 47). The mean total postoperative blood loss (intraoperative and drain output) was significantly higher in the group with a subfascial drain than in the no-drain group (1,008 ml (SD 520) vs 631 ml (SD 518); p < 0.001). The drop in haemoglobin level did not differ between the study groups over the postoperative timepoints (p = 0.290). The 48-hour opioid consumption was significantly higher in the no-drain group (2.0 mg/kg (SD 0.9) vs 1.4 (SD 0.6); p = 0.005). Two patients in the no-drain and one patient in the drain group developed a surgical site infection. Conclusion. Leaving the subfascial drain out after pedicle screw instrumentation for AIS is not associated with higher postoperative haemoglobin levels. Patients treated without a subfascial drain needed 30% more opioids during the first 48 hours than those who had a drain. Cite this article: Bone Joint J 2022;104-B(9):1067–1072

Aims

To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS).

Aims

In a multicentre, randomised study of adolescents undergoing posterior spinal fusion for idiopathic scoliosis, we investigated the effect of adding gelatine matrix with human thrombin to the standard surgical methods of controlling blood loss.

Objective

A clinical investigation into a new bone void filler is giving first data on systemic and local exposure to the anti-infective substance after implantation.

Introduction and Aims: Incidental dural tears and cerebrospinal fluid (CSF) leaks are common complications of spinal surgery. Collagen matrix (DuraGen, Integra LifeSciences) derived from bovine flexor tendons allows CSF absorption up to 100 times its weight without a volume change. Aim of this study was categorising the dural tears and monitoring post-operative complications. Method: In this three-year prospective study, 35 patients (22 males, 13 females; mean age 53.8 years (range 16–82)) were selected by the following criteria: (1) any spine operation resulting in intra-operative CSF leak due to dural tear; or (2) persistent post-operative CSF leak. Collagen matrix was cut according to the extent of the dural defect (pinhole, < 1cm, 1–2 cm, and > 2cm). Dural matrix was moistened and applied as a graft and overlying tissues were meticulously reconstituted. Collagen sponge was not sutured on the dura. Subfascial drain was used at the discretion of surgeon to avoid hematoma and blood loss. Results: The 39 procedures were as follows: 23 laminectomies, six diskectomies, four hematoma repairs, three structural repairs, two fracture stabilisations and one cystectomy. The locations of the 39 procedures were: 27 lumbar, seven thoracic, and five cervical. In 33 of 39 procedures, hemovac subfascial drain was used to avoid hematoma and excessive blood loss. Fibrin glue was used in two cases only. In 13 cases the dural defect was > 2cm, five cases 1–2cm, five cases < 2cm, and nine were pinhole defects. Of importance was the successful repair of 13 large dural tears (> 2cm) using the collagen sponge. Our study showed a 97.4% success rate for repairing dural tears using the collagen sponge surpassing the established techniques success rates by up to 10%. There were no wound infections post-operatively, versus the 6% rate of deep wound infection using the standard suture and fibrin glue. The mean follow-up time was 3.1 months. In two out of 39 procedures collagen sponge was used to repair persistent post-operative CSF leaks (no dural sponge used in the original operation). Conclusion: Considering the technical challenge of dural tears, especially ventral or lateral tears, the use of collagen sponge offers an excellent alternative mini-mising a prolonged procedure, wound infection, use of tissue grafts, as well as excessive blood loss. This study showed collagen sponge to be effective as a permanent dural substitute

In order to identify the risk factors and the incidence of post-operative spinal epidural haematoma, we analysed the records of 14 932 patients undergoing spinal surgery between 1984 and 2002. Of these, 32 (0.2%) required re-operation within one week of the initial procedure and had an International Classification of Diseases (ICD)-9 code for haematoma complicating a procedure (998.12). As controls, we selected those who had undergone a procedure of equal complexity by the same surgeon but who had not developed this complication. Risks identified before operation were older than 60 years of age, the use of pre-operative non-steroidal anti-inflammatories and Rh-positive blood type. Those during the procedure were involvement of more than five operative levels, a haemoglobin < 10 g/dL, and blood loss > 1 L, and after operation an international normalised ratio > 2.0 within the first 48 hours. All these were identified as significant (p < 0.03). Well-controlled anticoagulation and the use of drains were not associated with an increased risk of post-operative spinal epidural haematoma.