Intracerebral haemorrhage following spine surgery: a word of caution on the use of suction drains

Intracranial haemorrhage (ICH) is a rare but devastating complication post spinal surgery. We present three cases of post spine surgery ICH that were associated with high drain outputs postoperatively. The first patient underwent C1-C6 instrumented fusion and C4-C6 decompression. 950 mls hemoserous fluid was drained via suction drain immediately postoperatively. He suffered cerebral hemorrhage with tonsillar herniation and was brain dead on the same night. The second patient underwent C1-T1 instrumented fusion with C3-C4 decompression. 400 mls hemoserous fluid was drained via suction drain shortly after skin closure. He suffered subdural hemorrhage, subarachnoid hemorrhage and intraventricular hemorrhage, with persistent neurologic deficits and required long-term institutionalised care. The third patient underwent L2-L4 decompression and instrumented fusion. 480 mls hemoserous fluid was drained via suction drain 2 hours postoperatively. He suffered subdural haemorrhage but eventually recovered fully. An excessive drain output, especially within first few minutes to hours postoperatively, may signify a CSFleak. Suction drains should be used with caution in these cases as negative suction in the presence of a dura tear increases risk of post spine surgery ICH. In these cases, the use of non-suction drains should be considered.