scholarly journals High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion

2017 ◽  
Vol 26 (3) ◽  
pp. 363-367 ◽  
Author(s):  
Junichi Kushioka ◽  
Tomoya Yamashita ◽  
Shinya Okuda ◽  
Takafumi Maeno ◽  
Tomiya Matsumoto ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Interbody Fusion ◽  
Surgical Techniques ◽  
Posterior Lumbar Interbody Fusion ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
High Dose ◽  
Lumbar Interbody Fusion ◽  
Single Level

OBJECTIVE Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. Previous studies included limitations in terms of different TXA dose regimens, different levels and numbers of fused segments, and different surgical techniques. Therefore, the authors decided to strictly limit TXA dose regimens, surgical techniques, and fused segments in this study. There have been no reports of using TXA for prevention of intraoperative and postoperative blood loss in posterior lumbar interbody fusion (PLIF). The purpose of the study was to evaluate the efficacy of high-dose TXA in reducing blood loss and its safety during single-level PLIF. METHODS The study was a nonrandomized, case-controlled trial. Sixty consecutive patients underwent single-level PLIF at a single institution. The first 30 patients did not receive TXA. The next 30 patients received 2000 mg of intravenous TXA 15 minutes before the skin incision was performed and received the same dose again 16 hours after the surgery. Intra- and postoperative blood loss was compared between the groups. RESULTS There were no statistically significant differences in preoperative parameters of age, sex, body mass index, preoperative diagnosis, or operating time. The TXA group experienced significantly less intraoperative blood loss (mean 253 ml) compared with the control group (mean 415 ml; p < 0.01). The TXA group also had significantly less postoperative blood loss over 40 hours (mean 321 ml) compared with the control group (mean 668 ml; p < 0.01). Total blood loss in the TXA group (mean 574 ml) was significantly lower than in the control group (mean 1080 ml; p < 0.01). From 2 hours to 40 hours, postoperative blood loss in the TXA group was consistently significantly lower. There were no perioperative complications, including thromboembolic events. CONCLUSIONS High-dose TXA significantly reduced both intra- and postoperative blood loss without causing any complications during or after single-level PLIF.

scholarly journals Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion

2017 ◽  
Vol 26 (4) ◽  
pp. 435-440 ◽  
Author(s):  
Tomiya Matsumoto ◽  
Shinya Okuda ◽  
Takafumi Maeno ◽  
Tomoya Yamashita ◽  
Ryoji Yamasaki ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Control Group ◽  
Sagittal Imbalance ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
Radiographic Parameters ◽  
Whole Spine ◽  
The Relationship

OBJECTIVE The importance of spinopelvic balance and its implications for clinical outcomes after spinal arthrodesis has been reported in recent studies. However, little is known about the relationship between adjacent-segment disease (ASD) after lumbar arthrodesis and spinopelvic alignment. The purpose of this study was to clarify the relationship between spinopelvic radiographic parameters and symptomatic ASD after L4–5 single-level posterior lumbar interbody fusion (PLIF). METHODS This was a retrospective 1:5 matched case-control study. Twenty patients who had undergone revision surgery for symptomatic ASD after L4–5 PLIF and had standing radiographs of the whole spine before primary and revision surgeries were enrolled from 2005 to 2012. As a control group, 100 age-, sex-, and pathology-matched patients who had undergone L4–5 PLIF during the same period, had no signs of symptomatic ASD for more than 3 years, and had whole-spine radiographs at preoperation and last follow-up were selected. Mean age at the time of primary surgery was 68.9 years in the ASD group and 66.7 years in the control group. Several radiographic spinopelvic parameters were measured as follows: sagittal vertical axis (SVA), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis at L4–5 (SL) in the sagittal view, and C7–central sacral vertical line (C7-CSVL) in the coronal view. Radiological parameters were compared between the groups. RESULTS No significant change was found between pre- and postoperative radiographic parameters in each group. In terms of preoperative radiographic parameters, the ASD group had significantly lower LL (40.7° vs 47.2°, p < 0.01) and significantly higher PT (27° vs 22.9°, p < 0.05) than the control group. SVA ≥ 50 mm was observed in 10 of 20 patients (50%) in the ASD group and in 21 of 100 patients (21%, p < 0.01) in the control group. PI-LL ≥ 10° was noted in 15 of 20 patients (75%) in the ASD group and in 40 of 100 patients (40%, p < 0.01) in the control group on preoperative radiographs. Postoperatively, the ASD group had significantly lower TK (22.5° vs 30.9°, p < 0.01) and lower LL (39.3° vs 48.1°, p < 0.05) than the control group had. PI-LL ≥ 10° was seen in 15 of 20 patients (75%) in the ASD group and in 43 of 100 patients (43%, p < 0.01) in the control group. CONCLUSIONS Preoperative global sagittal imbalance (SVA > 50 mm and higher PT), pre- and postoperative lower LL, and PI-LL mismatch were significantly associated with ASD. Therefore, even with a single-level PLIF, appropriate SL and LL should be obtained at surgery to improve spinopelvic sagittal imbalance. The results also suggest that the achievement of the appropriate LL and PI-LL prevents ASD after L4–5 PLIF.

scholarly journals Tranexamic acid reduce hidden blood loss in posterior lumbar interbody fusion (PLIF) surgery

Medicine ◽  
2020 ◽  
Vol 99 (11) ◽  
pp. e19552
Author(s):  
Derong Xu ◽  
Xin Chen ◽  
Zheng Li ◽  
Zhinan Ren ◽  
Qianyu Zhuang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Hidden Blood Loss

scholarly journals Tranexamic Acid for Blood Loss after Transforaminal Posterior Lumbar Interbody Fusion Surgery: A Double-Blind, Placebo-Controlled, Randomized Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Bin He ◽  
Yuanqiang Li ◽  
Shuai Xu ◽  
Yunsheng Ou ◽  
Jinqiu Zhao
Keyword(s):  
Blood Loss ◽  
Adverse Events ◽  
Tranexamic Acid ◽  
Interbody Fusion ◽  
Control Group ◽  
Lumbar Interbody Fusion ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Drainage Time ◽  
Postoperative Drainage

Background. Transforaminal lumbar interbody fusion (TLIF) may result in significant blood loss and an increase in blood transfusion. Though tranexamic acid (TXA) is widely studied for the hemostasis of arthroplasty, there is little information on the use of TXA for TLIF surgery. Methods. This prospective randomized, double-blind, placebo-controlled trial was conducted to study the influence of TXA (intravenous bolus of 10 mg/kg 15 minutes before skin incision followed by intravenous infusion of 6-8 mg/kg/h up to a total dose of 15 mg/kg during the surgery) on the blood loss and Enhanced Recovery After Surgery (ERAS) after TLIF surgery. 40 patients were randomized into two groups: TXA group (tranexamic acid) and control group (placebo). Baseline characteristics were comparable between the TXA group and the control group before the surgery. Outcomes assessed included blood loss, total postoperative drainage, time for drainage removal, time to ambulation, hospital stay after surgery, postoperative hemoglobin (Hb) one day after surgery, and adverse events. Results. Compared to patients in the control group after TLIF surgery, patients in the TXA group have significantly reduced intraoperative hemorrhage and time to ambulation after surgery but show similar hospital stay, postoperative drainage, time for drainage removal, postoperative Hb one day after surgery, and adverse events. Conclusions. TXA shows important ability in controlling blood loss and promoting the ERAS after TLIF surgery.

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