The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI

Abstract

In this study we aimed to evaluate the role of closed-suction drainage on the extent of epidural fibrosis (EF) after lumbar disc surgery and to define a new grading system of epidural fibrosis in these patients, based on magnetic resonance imaging. Seventy-nine patients (34 women, 45 men) with a unilateral, single-level lumbar disc herniation were included in this study. Forty-one patients in whom closed-suction drainage was implanted were compared with 38 patients in whom the drain was not implanted. We have used a new grading system for the extent of epidural fibrosis, on the basis of follow-up magnetic resonance imaging findings. Pain intensity was evaluated by visual analog scale (VAS), and the patients' function and working ability were measured according to the Prolo functional-economic scale. We conclude that, in patients operated on for unilateral, single-level lumbar disc hernias, implantation of closed-suction drainage into the operation site results in less formation of EF radiologically and yields better clinical outcome.

Fig. 1

Left column shows grading system of epidural fibrosis and explanation; center column demonstrates schematic representation of our grading system; right column depicts the corresponding MR images (since we did not see any grade IV epidural fibrosis, there is no MR image for this category). (EF epidural fibrosis, TS thecal sac, DH defect of hemilaminectomy)

Fig. 2

Graph showing the relation between epidural fibrosis and closed-suction-drain (CSD) implantation