Four-Level Anterior Cervical Discectomy and Fusion Without the Use of a Postoperative Drain:

Study Design: Retrospective review. Objective: To investigate perioperative outcomes in patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) over a 10-year period with or without a postoperative drain. Background: ACDF is a common surgical treatment for degenerative cervical spine conditions, and the approach includes a unique set of complications. Several studies have suggested that postoperative drains do not significantly impact the incidence of dysphagia, hematoma, and other complications in multilevel ACDF. However, there is no literature investigating postoperative outcomes without subfascial drains in patients who underwent 4-level ACDF. Materials and Methods: We performed a retrospective review of all patients who underwent a 4-level ACDF by a single surgeon at our institution between 2014 and 2024. Patient data were collected through direct record review. Patients were grouped based on whether a subfascial drain was used. Outcomes included rates of postoperative hematoma, dysphagia, all-cause cervical spine reoperation, length of stay, operative time, estimated blood loss, and prevertebral soft tissue swelling (PSTS). Statistical analyses were performed to assess outcome differences between the two groups. Results: We identified 97 patients over a 10-year period: 36 without a drain and 61 with a drain. The mean follow-up times were 904 days and 655 days, respectively. There were no significant differences in demographic data or comorbid conditions between the groups. Two patients in the drain group developed a postoperative hematoma, compared with none in the no-drain group ( P = 0.74). There were no significant differences between groups with regard to dysphagia, infection, operative time, estimated blood loss, length of stay, or prevertebral soft tissue swelling measurements. Conclusions: Rates of complications were not significantly associated with the use of surgical drains in 4-level ACDF. In select patients in whom meticulous hemostasis is achieved, a postoperative drain is not required.