Abstract:Objective To explore the incidence and precautionary methods of typical drainage-related pain (TDRP) after lumbar surgery. Methods The clinical data of 336 patients with degenerative lumbar disease, who underwent singlelevel posterior lumbar interbody fusion (PLIF) surgery from Jan. 2015 to Jan. 2017 in Orthopaedics Department of Changhai Hospital of Naval Medical University (Second Military Medical University), were retrospectively analyzed. The incidence and relief methods of TDRP were compared between the patients with exit point of muscle of drainage tube at L3, L4, L5 and S 1 levels. A total of 100 patients with degenerative lumbar disease, who underwent single-level transforaminal lumbar interbody fusion (TLIF) surgery from Jun. 2017 to Jun. 2018 in Orthopaedics Department of Changhai Hospital of Naval Medical University (Second Military Medical University), were prospectively enrolled. One side of the patients was randomly selected as L 4 group and the other side as L5 group. The exit points of muscle of drainage tubes in L4 group were in line with the superior endplate of the L4, and those in L5 group were in line with the inferior endplate of the L5. The incidence and relief methods of TDRP, drainage volume, drainage duration, dressing saturation grades and wound complications were compared between the two groups after surgery. Results There were no significant differences in gender, age, body mass index (BMI), operation time, intraoperative blood loss, postoperative drainage volume, drainage duration, duration of fever, or hemoglobin or hematocrit one day before surgery, three days after surgery and at discharge between the patients with TDRP (n=65) and without TDRP (n=271) after PLIF (all P>0.05). There were 63, 94, 110 and 69 patients with exit points of muscle of drainage tube at L3, L4, L5 and S1 levels, respectively; and the incidence rates of TDRP were 0, 5.32% (5 cases), 29.09% (32 cases) and 40.58% (28 cases), respectively. Among the 65 patients with TDRP, four patients (6.15%) were relieved after removal of drainage tube, five patients (7.69%) had sudden relief by changing body position after drainage tube removal, 39 patients (60.00%) were relieved obviously by thermotherapy (generally within two months) after drainage tube removal, 12 patients (18.46%) were relieved by non-steroidal anti-inflammatory drugs after removal of drainage tube, and five patients (7.69%) were relieved by local blockage after the drainage tube removal. In the prospective study, there were no significant differences in postoperative drainage volume, drainage duration, wound dressing two days after surgery or the incidence of wound complications between the L4 group and L5 group (all P>0.05). The incidence rate of TDRP was significantly higher in the L 5 group than that in the L4 group (39.00%[39/100]vs 4.00%[4/100], χ2=36.291, P<0.01). Pain symptoms of 71.79% (28/39) and 75.00% (3/4) patients could be relieved by thermotherapy after removal of drainage tube in the L5 group and the L 4 group, respectively. Conclusion The incidence of TDRP is high in patients with lumbar degenerative disease whose exit points of muscle of drainage tubes are at or below the level of the L5 vertebral body after surgery. It is suggested that the exit points of muscle of drainage tubes should be above the level of L5 vertebral body after lumbar surgery.