Delayed incidental dural tears from subfascial drains after spine surgery: illustrative cases

Background: Placement of a subfascial drain following open spine surgery is common practice to mitigate postoperative complications, including epidural hematoma, seroma formation, surgical site infection, and wound dehiscence. The authors present 3 cases in which subfascial Hemovac drains were associated with postoperative durotomy following otherwise uncomplicated lumbar surgeries.

Observations: Three patients who underwent single-level lumbar surgery requiring postoperative drain placement subsequently developed CSF leaks, presumed to be secondary to intracorporeal drain movement consistent with the Euler buckling theory.

Lessons: In patients undergoing uncomplicated single-level lumbar spine surgery, consideration should be given to the use of a silicone Jackson-Pratt drain rather than a compression-resistant polyvinyl chloride Hemovac drain. In a small surgical bed, a shorter and more compliant drain may be sufficient, whereas a stiff drain may act as a trocar. https://thejns.org/doi/10.3171/CASE2640.