Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Is Tranexamic Acid an Effective Prevention in the Formation of Epidural Fibrosis? Histological Evaluation in the Rats

  • Esra Circi (Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital) ;
  • Yunus Atici (Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital) ;
  • Alican Baris (Department of Orthopaedics and Traumatology, Istanbul Haydarpasa Numune Education and Research Hospital) ;
  • Ahmet Senel (Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital) ;
  • Cem Leblebici (Department of Pathology, Istanbul Education and Research Hospital) ;
  • Saltuk Bugra Tekin (Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital) ;
  • Yusuf Ozturkmen (Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital)
  • Received : 2022.11.21
  • Accepted : 2023.02.21
  • Published : 2023.09.01
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Abstract

Objective : The present study aimed to determine the topical and systemic efficacy of tranexamic acid (TXA) on epidural fibrosis in a rat laminectomy model. Methods : Thirty-two 12-month-old adult Sprague-Dawley rats were used in this study. Each rat underwent bilateral laminectomy at the L1 and L2 vertebral levels. Rats were divided into four groups : in group I (control group, n=8), a laminectomy was performed and saline solution was applied into the surgical space. In group II (topical group, n=8), laminectomy was performed and 30 mg/kg TXA was applied to the surgical site before skin closure. In group III (systemic group, n=8), 30 mg/kg TXA was administered intravenously via the tail vein in the same session as the surgical procedure. In group IV (topical and systemic group, n=8), TXA was administered 30 mg/kg both topical and intravenous. The rats were sacrificed at 4 weeks postoperatively. Masson's trichrome and hematoxylin and eosin were used to assess acute inflammatory cells, chronic inflammatory cells, vascular proliferation, and epidural fibrosis. Results : Epidural fibrosis, acute inflammation, chronic inflammation, and sum histologic score value were significantly lower in the systemic TXA group, systemic and topical TXA groups than in the control group (p<0.05). In addion, the sum histologic score was significantly lower in the topical TXA group than in the control group (p<0.05). Conclusion : In this study, epidural fibrosis formation was prevented more by systemic application, but the topical application was found to be effective when compared to the control group. As a result, we recommend the systemic and topical use of TXA to prevent epidural fibrosis during spinal surgery.

Keywords

References

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