gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Use of intraoperative drainage systems in spine surgery: Results of a nationwide online questionnaire

Meeting Abstract

  • Kajetan von Eckardstein - Klinik für Neurochirurgie, Universitätsmedizin Göttingen
  • Jaqueline Dohmes - Klinik für Neurochirurgie, Universitätsmedizin Göttingen
  • Stefan Lakemeier - Klinik für Orthopädie, Universitätsmedizin Göttingen
  • Wolfgang Schultz - Klinik für Orthopädie, Universitätsmedizin Göttingen
  • Veit Rohde - Klinik für Neurochirurgie, Universitätsmedizin Göttingen

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.05.03

doi: 10.3205/14dgnc021, urn:nbn:de:0183-14dgnc0215

Published: May 13, 2014

© 2014 von Eckardstein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The risks of intraoperative drains in spine surgery (e.g. bleeding, CSF leakage, and infections) have to be balanced to the benefits (e.g. reduced rate of postoperative hematoma and seroma formation). Little is known about factors influencing the surgeons decision for or against a drain.

Method: We conducted a survey among German spine surgeons regarding their use of drains. Neurosurgical and Orthopedic Departments as well as neurosurgeons in private practice were invited by E-mail to complete an online questionnaire featuring general and case specific questions regarding drain placement.

Results: We have received 103 questionnaires (private practice 23, small and medium hospitals 57, university hospitals 23). Factors likely influencing the decision for placement of a drain include size of surgical wound, type of procedure, hemostasis at the end of the procedure, and possible coagulopathies; factors less important are overall blood loss, body mass index, and implants. The majority of surgeons believe that drain associated infections increase significantly after 3 to 4 days. 31% of surgeons will use drains for single level lumbar microdiscectomies (single level cervical anterior discectomy and fusion: 58%; single level cervical laminoplasty: 62%; lumbar hemilaminectomy for bisegmental spinal stenosis: 69%; transpedicular instrumentation: 88%; vertebral body replacement for metastasis: 94%). While some surgeons discontinue the drain after a certain number of days, an equal number of colleagues assess the amount of fluid drained; however, almost all will take out the drain by postoperative day 4. Although half of the surgeons believe that a postoperative seroma collection can be effectively treated by drains, only very few are convinced that wound closure will improve as a result of seroma reduction. Over half of those usually placing a drain in a spine case will not use a drain in cases of unintentional dural opening. One colleague warned that not placing a drain might leave the surgeon legally responsible for postoperative hemorrhages.

Conclusions: In terms of indication, duration, and safety measures use of drainage systems in spinal surgery is very heterogeneous. The majority of surgeons prefer drains to suction for most of their spinal cases, except of lumbar microdiscectomies where only 31% will use a drain. Almost all colleagues will discontinue the drains after postoperative day 4.