中心脊柱管狭窄症に対する後外側腰椎器械固定術におけるトラネキサム酸：臨床研究

Study DesignProspective Study.ObjectivesDegenerative lumbar central spinal stenosis (DLCCS) commonly affects the elderly, causing back and leg pain that often necessitates surgical intervention. Perioperative tranexamic acid (TXA) effectively reduces blood loss in lumbar instrumented fusion surgeries. Its effectiveness in elderly patients undergoing posterolateral lumbar instrumented fusion and posterior decompression for DLCCS remains insufficiently investigated. This study aims to evaluate the potential benefits of TXA in these surgical interventions.Methods170 patients with DLCCS that underwent posterolateral lumbar instrumented fusion with posterior decompression at two consecutive vertebral levels were included. Patients were divided into two groups: Group A (87) without intravenous TXA and Group B (83) with intravenous TXA 30 minutes preoperatively. Outcomes included intraoperative blood loss, postoperative drainage, transfusion rates, surgical duration, initiation of mobilization and hospital stay.ResultsNo significant differences were found in patients' baseline demographics. Surgical duration was significantly shorter in the TXA group (103.6 ± 9.8 min vs 128.6 ± 8.2 min, P < 0.001). Intraoperative blood loss was lower in the TXA group (462.7 ± 92.0 mL vs 864.4 ± 157.0 mL, P < 0.001), as was postoperative drainage (85.2 ± 47.6 mL vs 207.4 ± 153.5 mL, P < 0.001). Postoperative transfusion was required in 3 TXA patients vs 27 in the non-TXA group (P < 0.001). TXA patients mobilized earlier (7.4 ± 3.4 hours vs 12.1 ± 8.1 hours, P < 0.001) and had a shorter hospital stay (2.1 ± 0.4 days vs 2.6 ± 0.9 days, P < 0.001).ConclusionsPreoperative TXA administration in this spinal surgery improved surgical and postoperative outcomes and should be considered more.