The Effect of Tranexamic Acid Administration on Early Endothelial Damage Following Posterior Lumbar Fusion Surgery

Tranexamic acid (TXA) protects against endothelial glycocalyx injury in vitro. We aimed to evaluate whether TXA could protect against endothelial glycocalyx degradation in patients undergoing posterior lumbar fusion surgery. Patients aged 30–80 years were enrolled. The TXA group was administered a loading dose of 10 mg/kg, followed by a 1 mg/kg/h infusion. Serum syndecan-1 and heparan sulfate concentrations, which are biomarkers of glycocalyx degradation, were measured at preoperative baseline (T0), immediately post-surgery (T1), and 2 h post-surgery (T2). Postoperative complications were assessed, including hypotension, desaturation, and acute kidney injury. Among the 121 patients who completed the study, 60 received TXA. There were no significant differences in the marker concentrations at each time point. However, the postoperative increase in syndecan-1 levels from baseline was significantly attenuated in the TXA group compared with the control group (median (interquartile range); T1 vs. T0: −1.6 (−5.3–2.6) vs. 2.2 (−0.7–4.8), p = 0.001; T2 vs. T0: 0.0 (−3.3–5.5) vs. 3.6 (−0.1–9.3), p = 0.013). Postoperative complications were significantly associated with the magnitude of the change in syndecan-1 levels (for T2 vs. T0: odds ratio: 1.08, 95% confidence interval: 1.02–1.14, p = 0.006). TXA administration was associated with reduced syndecan-1 shedding in patients undergoing posterior lumbar fusion surgery.

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Two Doses of Tranexamic Acid Reduce Blood Loss in Primary Posterior Lumbar Fusion Surgery

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000999 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Xianren Zhu ◽

Qian Shi ◽

Dongya Li ◽

Jibin Wu ◽

Kaijin Guo ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Lumbar Fusion ◽

Reduce Blood Loss ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery

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The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery

European Spine Journal ◽

10.1007/s00586-021-06960-8 ◽

2021 ◽

Author(s):

Shane Shahrestani ◽

Andy Ton ◽

Xiao T. Chen ◽

Alexander M. Ballatori ◽

Jeffrey C. Wang ◽

...

Keyword(s):

Postoperative Complications ◽

Geriatric Patients ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Single Level ◽

Lumbar Fusion Surgery

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Hidden blood loss and the risk factors after posterior lumbar fusion surgery

Medicine ◽

10.1097/md.0000000000020103 ◽

2020 ◽

Vol 99 (19) ◽

pp. e20103

Author(s):

Fei Lei ◽

Zhongyang Li ◽

Wen He ◽

Xinggui Tian ◽

Lipeng Zheng ◽

...

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery ◽

Hidden Blood Loss

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Microdialysis of paraspinal muscle in healthy volunteers and patients underwent posterior lumbar fusion surgery

European Spine Journal ◽

10.1007/s00586-009-1021-x ◽

2009 ◽

Vol 18 (11) ◽

pp. 1604-1609 ◽

Cited By ~ 6

Author(s):

Gang Ren ◽

Søren Eiskjær ◽

Jon Kaspersen ◽

Finn Bjarke Christensen ◽

Sten Rasmussen

Keyword(s):

Healthy Volunteers ◽

Lumbar Fusion ◽

Paraspinal Muscle ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery

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Faculty Opinions recommendation of Incidence, Predictors, and Postoperative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 13,695 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.729591403.793542990 ◽

2018 ◽

Author(s):

Federico Bilotta

Keyword(s):

Quality Improvement ◽

Postoperative Complications ◽

Blood Transfusion ◽

Lumbar Fusion ◽

Improvement Program ◽

Surgical Quality ◽

Fusion Surgery ◽

Lumbar Fusion Surgery ◽

American College Of Surgeons ◽

Complications Of Blood Transfusion

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A case of pituitary apoplexy following posterior lumbar fusion surgery

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine14792 ◽

2015 ◽

Vol 23 (5) ◽

pp. 598-601 ◽

Cited By ~ 3

Author(s):

Akın Akakın ◽

Baran Yılmaz ◽

Murat Şakir Ekşi ◽

Türker Kılıç

Keyword(s):

Pituitary Adenoma ◽

Pituitary Apoplexy ◽

Lumbar Fusion ◽

Rare Complication ◽

Interdisciplinary Approach ◽

Electrolyte Imbalance ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery ◽

First Case

Pituitary adenoma is a common primary brain neoplasm. Pituitary apoplexy (PA) is a rare complication of pituitary adenoma and occurs as the result of sudden tumor growth and following different comorbidities. The authors describe the first case of PA following posterior lumbar fusion surgery performed while the patient was prone. In patients with a preexisting pituitary adenoma, thorough clinical and laboratory investigations should be conducted using an interdisciplinary approach before any planned surgery. In unknown cases of pituitary adenoma, PA should be kept in mind for the differential diagnosis in a case with headache, nausea, vomiting, ophthalmoplegia, visual loss, and electrolyte imbalance concurrent with an ongoing disease state.

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Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02032-7 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Tao Wang ◽

Wenyuan Ding

Keyword(s):

Risk Factors ◽

Lumbar Fusion ◽

Meta Analysis ◽

Adjacent Segment Degeneration ◽

Cochrane Library ◽

Adjacent Segment ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery ◽

History Of

Abstract Study design A meta-analysis. Objective We performed a meta-analysis to explore the incidence and risk factors of adjacent segment degeneration (ASD) after posterior lumbar fusion surgery. Methods An extensive search of the literature was performed in English database of PubMed, Embase, and Cochrane Library, and Chinese database of CNKI and WANFANG (up to May 2020). We collected factors including demographic data, surgical factor, and sagittal parameters. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results Finally, 19 studies were included in the final analysis. In our study, the rate of ASD after posterior lumbar fusion surgery was 18.6% (540 of 2896). Our data also showed that mean age, body mass index (BMI), the history of smoking and hypertension, preoperative adjacent disc degeneration, long-segment fusion, preoperative superior facet violation, high lumbosacral joint angle, pre- and post-operative L1-S1 sagittal vertical axis (SVA), post-operative lumbar lordosis (LL), and preoperative pelvic incidence (PI) were associated with the development of ASD. However, gender, history of diabetes, bone mineral density (BMD), preoperative Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA), the type of fusion (PLIF vs TLIF), type of bone graft (auto- vs allograft), fusion to S1(vs non-fusion to S1), diagnose (lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis), preoperative pelvic tilt (PT), LL and sacral slope (SS), post-operative SS, PT and PI were not associated with the development of ASD. Conclusions In our study, many factors were correlated with the risk of ASD after posterior lumbar fusion surgery. We hope this article can provide a reference for spinal surgeons in treatment for lumbar degenerative diseases.

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Combined Use of Intravenous and Topical Tranexamic Acid Efficiently Reduce Blood Loss in Patients Aged over 60 operated with 2-level lumbar fusion

10.21203/rs.2.22192/v2 ◽

2020 ◽

Author(s):

Jianjiang Li ◽

Long Wang ◽

Tao Bai ◽

Yanlu Liu ◽

Yifei Huang

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Lumbar Fusion ◽

Control Group ◽

Transfusion Rate ◽

Total Blood ◽

Fusion Surgery ◽

Combined Use ◽

Group A ◽

Hemoglobin Drop

Abstract Purpose: The current study was conducted to assess the efficacy and safety of the intravenous (IV) administration combined with topical administration of tranexamic acid （TXA）in patients (aged over 60) scheduled for 2-level lumbar fusion surgery. Methods: 280 patients scheduled for 2-level lumbar fusion surgery were randomized into four groups, including an IV group, a local group, a combined group, and a control group. Patients in the combined group, in the IV group, in the topical group, and in the control group were administrated with 15 mg/kg of IV-TXA + 2 g TXA in local,15 mg/kg IV-TXA, 2 g TXA in local ,and 100 ml IV, respectively. The results of total blood loss (TBL) , maximum hemoglobin drop, the transfusion rate, and the number of allogeneic blood units were compared. Deep venous thrombosis (DVT) and pulmonary embolism (PE) events were monitored and recorded. Results: The TBL was 635.49 ± 143.60, 892.62 ± 166.85, 901.11 ± 186.25, and 1,225.11 ± 186.25 mL for the combined group, the IV group, the topical group, and the control group, respectively.(p = 0.015, p = 0.001 respectively).The average maximum hemoglobin drop in the four above groups was 2.18 ± 0.24, 2.80 ± 0.37, 2.40 ± 0.64 ，and 3.40 ± 1.32 g/dL, respectively. No PE event was reported during the follow-up. Although asymptomatic DVT events was reported by 1, 2, and 2 patients in the combined group, topical group, and control group, respectively, there is no intergroup difference. Conclusions: The combined use of TXA effectively reduced total blood loss and blood transfusion rate in patients aged over 60 scheduled for 2-level lumbar fusion, without increasing the incidence of DVT and PE formation.

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