Berkay PAKER, Önder ERTEM, Mehmet Zeki YILDIZ, Yasin KART, Deniz KONYA
Journal of Turkish Spinal Surgery - 2026;37(2):50-57
Objective: Microscopic unilateral laminotomy for bilateral decompression (ULBD) is performed for symptomatic lumbar spinal stenosis in selected patients who do not require fusion. It is unknown whether a larger closed-suction drain improves postoperative drainage or early clinical outcomes after ULBD. We compared 12-French (12F) and 16-French (16F) drains after ULBD. Materials and Methods: We retrospectively analyzed 49 consecutive patients who underwent microscopic ULBD performed by a single team between May and December 2023. Patients received either a 12F (n=25) or a 16F (n=24) closed-suction drain under a uniform perioperative protocol. The primary outcome was total drain output (mL). Secondary outcomes were change in pain [Deltavisual analog scale (VAS)=preoperative minus postoperative VAS] and length of stay (LOS, days). Exploratory analyses assessed associations among drainage, DeltaVAS, and patient or surgical variables. Group comparisons were performed using parametric or non-parametric tests, as appropriate; multivariable linear regression was used to evaluate independent predictors. Results: Baseline demographics and clinical variables were similar between groups. No significant differences were observed between 12F and 16F drains in total output (p=0.607), DeltaVAS (p=0.935), postoperative VAS (p=0.837), or LOS (p=0.448). Prior surgery (p=1.000), anticoagulant or antiplatelet use (p=0.909), and surgical level distribution (p=0.265) did not differ between groups. Surgical extent was the only variable associated with higher drainage on univariate analysis (p<0.001). Higher preoperative VAS predicted greater DeltaVAS (Pearson's r=0.604, p<0.001). In multivariable models, preoperative VAS remained the principal predictor of DeltaVAS, while drain size was not an independent predictor of output or pain improvement. Conclusion: Upsizing closed-suction drains from 12F to 16F after microscopic ULBD did not reduce pain, shorten hospitalization, or change the total output. A 12F drain appears adequate for routine ULBD; surgical extent, rather than drain diameter, drives postoperative drainage volume.
