Abstract

Background: A wide variety of conditions can cause recurrent postoperative lumbar radiculopathy.

Case Description: A 49-year-old female developed sudden recurrent postoperative right leg pain after a right-sided L5S1 microdiskectomy for a herniated disc. Emergent magnetic resonance and computed tomography studies demonstrated migration of the drainage tube into the right L5S1 lateral recess compromising the S1 nerve root. Following drain removal, the patient’s right reg pain immediately resolved.

Conclusion: Migration of a lumbar wound drain into the operated lateral recess following a lumbar diskectomy may result in acute, recurrent/intractable radicular pain that was readily resolved with drain removal.

Keywords: Drainage tube, Lumber disc herniation, Radiculopathy, Spine surgery

INTRODUCTION

Placement of a drain in a lumbar wound following a lumbar diskectomy is a common practice to prevent postoperative epidural hematomas (EDH).[ 3 ] However, these drains may rarely migrate of into the lateral recess causing severe postoperative recurrent radicular pain. Here, after a right L5S1 microdiskectomy, a 49-year-old female developed severe recurrent radicular pain. When the postoperative magnetic resonance (MR)/computed tomography (CT) confirmed drain migration into the right L5S1 lateral recess, surgical removal of the drain resolved the patient’s root compression and complaints.

CASE DESCRIPTION

A 49-year-old female underwent a right L5S1 microdiskectomy for a lumber disc herniation. At surgery, a wound drain was placed [ Figures 1 and 2 ]. Immediately postoperatively, the patient’s symptoms resolved, and the immediate post-operative plain X-ray showed that the drain was located dorsal to the S1 lamina [ Figure 3a ]. However, by the next morning, she developed severe recurrent right-sided S1 radiculopathy. Now, the X-rays, MR, and CT studies all confirmed that the drain had migrated into the right L5S1 lateral recess [ Figures 3b and 4 ]. After drain removal, the right leg pain immediately resolved.

Figure 1:

(a and b) Preoperative magnetic resonance imaging. (a and b) T2-weighted image showed right S1 nerve root compression by lumber disc herniation (red arrow).

Figure 2:

(a and b) Postoperative photos of fixed drain tube with non-absorbable suture at the time of pain recurrence.

Figure 3:

(a and b) The comparative X-ray between postoperative day 0 and day 1. (a) Postoperative X-ray image at day 0. Drain was correctly placed dorsal to the S1 lamina. (b) Postoperative X-ray image at day 1. Drain was migrated into the right L5S1 lateral recess.

Figure 4:

(a and b) Postoperative magnetic resonance imaging. (a and b) T2-weighted image in sagittal section and constructive interference in steady state in coronal section showed spinal nerve root compression with drainage tube (red arrow). (c and d) Postoperative computed tomography (CT). (c and d) Drainage tube was migrated into the right L5S1 lateral recess on sagittal and axial CT images.

DISCUSSION

Recurrence of radicular pain after a lumber diskectomy is most commonly attributed to: Postoperative EDH contributing to cauda equina syndromes, cerebrospinal fluid leaks/fistulas (i.e., including root extrusion through durotomy sites or loculated cerebrospinal fluid compressing the cauda equina), or recurrent disc herniations.[ 1 , 2 , 4 , 5 ] In this case, following a right-sided L5S1 microdiskectomy, the X-rays, MR, and CT studies documented drain migration into the right L5S1 lateral recess that caused the recurrent right-sided S1 radiculopathy. Note, this “migration” occurred despite the drain being “tightly” sutured in place (i.e., to the skin). Following drain removal, the patient’s complaints immediately resolved.

CONCLUSION

Following lumbar diskectomy, wound drains may rarely migrate into the operated lateral recesses causing symptomatic recurrent radiculopathy. In these instances, X-ray, MR, and CT confirmation of drain migration should prompt early drain removal to achieve rapid symptom resolution.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

References

1. Glotzbecker MP, Bono CM, Wood KB, Harris MB. Postoperative spinal epidural hematoma: A systematic review. Spine (Phila Pa 1976). 2010. 35: E413-20

2. Heindel P, Tuchman A, Hsieh PC, Pham MH, D’Oro A, Patel NN. Reoperation rates after single-level lumbar discectomy. Spine (Phila Pa 1976). 2017. 42: E496-501

3. Mirzai H, Eminoglu M, Orguc S. Are drains useful for lumbar disc surgery? A prospective, randomized clinical study. J Spinal Disord Tech. 2006. 19: 171-7

4. Pavlou G, Bucur SD, van Hille PT. Entrapped spinal nerve roots in a pseudomeningocoele as a complication of previous spinal surgery. Acta Neurochir (Wien). 2006. 148: 215-9

5. Valente A, Nicodemo A, Bruno A, Massè A. Cerebrospinal fluid fistulas after iliosacral screw removal in post-traumatic pseudomeningocele. J Orthop Traumatol. 2012. 13: 111-4