Use of Topical Tranexamic Acid in Reducing Postoperative Bleeding in Single Level Posterior Lumbar Spinal Fusion Surgery: A Quasi-Experimental Study

Abstract

Background: Lumbar spondylolisthesis, spinal canal stenosis and spinal instability causing back pain, radiculopathy and neurogenic claudication are very common in neurosurgical practice. Many of them require surgical decompression of neural element with spinal fusion and instrumentation. Spinal fusion surgery is frequently associated with significant blood loss leading to many problems. Use of antifibrinolytics as a strategy of blood loss management may alleviate these problems.

Objective: To compare and determine whether the topical application of tranexamic acid can reduce postoperative bleeding in single level posterior lumbar spinal fusion surgery. Methods: This quasi-experimental study included 30 participants (15 per group) undergoing single-level posterior lumbar spinal fusion at the Department of Neurosurgery, BSMMU, Dhaka. Data were collected after informed consent, and postoperative drain output and removal time were compared with or without topical tranexamic acid application before wound closure. Data were analyzed using SPSS version 26 and presented as frequency, percentage, and mean (SD). Chi-square/Fisher’s exact tests and Wilcoxon rank-sum test were used, with p<0.05 considered statistically significant.

Results: In this study, the sociodemographic and clinical characteristics were identical between the study and control group. The study group demonstrated statistically significant reduction of postoperative drain collection following single level posterior lumbar spinal fusion surgery (p- value <0.001) and was associated with earlier drain removal which was also statistically significant (p- value 0.002).

Conclusion: Topical application of tranexamic acid significantly reduces postoperative bleeding in single level lumbar spinal fusion surgery, as evidenced by a 17% lower total drain output and earlier drain removal.