Indwelling Drains Are Not Necessary for Patients Undergoing One-level Anterior Cervical Fixation Surgery

Background: Anterior cervical discectomy and fusion (ACDF) has become a common procedure for cer- vical spine surgeries, since it is safe and effective in most patients. However, some patients develop life- threatening problems such as respiratory obstruction arising from rare postoperative hematoma and edema, although intraoperative bleeding caused by the connective tissue splitting procedure or bleeding caused by postoperative insertion of a suction tube has rarely been reported. Investigation of the re- quirement for indwelling drains in patients who undergo cervical spine surgery is necessary because of the pain, anxiety, and discomfort caused despite the use of high-quality materials. Methods: Enrolled in the study were 43 patients who underwent one-level anterior cervical fixation sur- gery, including 23 (randomly selected) who received an indwelling drain (group A, mean age: 57.78± 14.46 years, range: 39―82 years, male female: 13 10), and 20 who received no indwelling drain (group B, mean age: 57.00±13.99 years, range: 29―81 years, male female: 12 8). Intraoperative bleeding amounts, lateral views of plain cervical spine radiographs, prevertebral space (PVS) changes on plain radiographs and computed tomography (CT) images, wound inspections, and pain assessments on the Numeric Rating Scale (NRS) were compared between groups. In addition, a history of risk factors for bleeding, such as hypertension, diabetes, and cerebrovascular diseases which require antiplatelet ther- apy, was determined. Hepatic failure was observed in none of the patients. Results: Postoperative CT images obtained the day following surgery showed no densities indicating the presence of postoperative hematoma in any of the 43 patients. The maximum amount of intraopera- tive bleeding was 10 mL, with no significant difference between groups. No patients reported an obvi- ous pain level on NRS, but the pain was significantly milder in group B (A: 1.326±0.911, B: 0.555±0.556, p=0.0037). The postoperative PVS increment on plain radiographs was comparable between groups (A: 1.778±0.992, B: 1.730±0.966, p=0.8728). Discussion: Given the negligible intraoperative and postoperative bleeding observed in both groups, and the lack of difference in PVS increments between the groups, our results suggested that indwelling drains are not required for patients undergoing typical anterior cervical fixation surgery. However, it is important to take care of major vessels such as the superior and inferior thyroid arteries and the exter- nal jugular vein as well as the prevertebral venous plexus during surgery. (J Nippon Med Sch 2015; 82: 124―129)