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Tranexamic Acid in Posterolateral Lumbar Instrumented Fusion for Central Spinal Stenosis: A Clinical Study
Stylianos Kapetanakis1, Mikail Chatzivasiliadis1, Georgios Charitoudis1
1Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
Global Spine Journal
|December 27, 2025
Summary
Perioperative tranexamic acid (TXA) significantly reduces blood loss and improves surgical outcomes in elderly patients undergoing spinal stenosis surgery. This treatment led to shorter surgery times, earlier mobilization, and reduced hospital stays.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Geriatric Medicine
Background:
- Degenerative lumbar central spinal stenosis (DLCCS) is a common condition in the elderly, often leading to pain and requiring surgical intervention.
- Perioperative tranexamic acid (TXA) is known to reduce blood loss in spinal fusion surgeries, but its specific benefits in elderly DLCCS patients are not well-established.
Purpose of the Study:
- To evaluate the effectiveness of intravenous tranexamic acid (TXA) in elderly patients undergoing posterolateral lumbar instrumented fusion with posterior decompression for DLCCS.
- To assess the impact of TXA on intraoperative blood loss, postoperative drainage, transfusion rates, surgical duration, mobilization, and hospital stay.
Main Methods:
- A prospective study included 170 elderly patients with DLCCS undergoing two-level posterolateral lumbar instrumented fusion and posterior decompression.
- Patients were divided into two groups: one receiving preoperative intravenous TXA (Group B, n=83) and a control group without TXA (Group A, n=87).
- Outcomes measured included blood loss, drainage, transfusion requirements, surgery length, time to mobilization, and hospital stay duration.
Main Results:
- The TXA group exhibited significantly reduced intraoperative blood loss (462.7 mL vs 864.4 mL) and postoperative drainage (85.2 mL vs 207.4 mL) compared to the control group (P < 0.001).
- Surgical duration was shorter (103.6 min vs 128.6 min), and postoperative transfusion rates were significantly lower in the TXA group (P < 0.001).
- Patients receiving TXA mobilized earlier (7.4 hours vs 12.1 hours) and had shorter hospital stays (2.1 days vs 2.6 days) (P < 0.001).
Conclusions:
- Preoperative administration of tranexamic acid (TXA) significantly improves surgical and postoperative outcomes in elderly patients undergoing lumbar decompression and fusion for DLCCS.
- TXA demonstrated benefits including reduced blood loss, shorter surgery and hospital stay, and earlier mobilization.
- The findings suggest that TXA should be strongly considered as an adjunct therapy for this patient population.
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