Preoperative Local Infiltration of Tranexamic Acid in Posterior Lumbar Fusion: A Prospective Controlled Study

Introduction Posterior instrumented lumbar fusion (PLIF) is a commonly performed surgical procedure for degenerative lumbar spine disorders such as lumbar disc herniation, spinal stenosis, and spondylolisthesis. However, the procedure is frequently associated with significant intraoperative and postoperative blood loss due to extensive soft tissue dissection, exposure of cancellous bone, and injury to the epidural venous plexus. Excessive blood loss may result in postoperative anemia, increased transfusion requirements, delayed mobilization, prolonged hospital stay, and increased morbidity. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has been widely used to reduce blood loss in orthopedic and spine surgeries. This study aimed to evaluate the effectiveness of preoperative local infiltration of TXA in reducing perioperative blood loss in posterior lumbar fusion surgery. Methodology This prospective controlled study was conducted in the Department of Orthopedics, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, from March 2023 to June 2024. A total of 40 patients with degenerative lumbar spine disorders planned for 2-3 level posterior lumbar fixation with or without interbody fusion were included and randomly allocated into two groups. Group 1 (n=20) received 1 g of TXA by preoperative local infiltration bilaterally into the paraspinal muscles before skin incision, while Group 2 (n=20) served as the control group without TXA infiltration. Demographic characteristics, preoperative hematological parameters, intraoperative blood loss, postoperative drain output on postoperative days (PODs) 1, 2, and 3, and postoperative hemoglobin and packed cell volume (PCV) were recorded. Statistical analysis was performed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA), with p<0.05 considered statistically significant. Results Baseline demographic and preoperative hematological parameters were comparable between the groups. Although intraoperative blood loss was lower in the TXA group, the difference was not statistically significant. Postoperative drain output was significantly reduced in the TXA group on PODs 2 and 3 (p=0.006 and p<0.001, respectively). POD 3 hemoglobin and PCV were significantly higher in the TXA group (12.74±0.87 g/dL and 37.44±0.86%) compared to the control group (11.33±0.80 g/dL and 34.84±1.66%, respectively), with p<0.001 for both. The reduction in hemoglobin and PCV was significantly less in the TXA group. Conclusion Preoperative local infiltration of TXA is an effective and safe method for reducing postoperative blood loss and preserving postoperative hematological parameters in posterior instrumented lumbar fusion surgery. This technique may reduce transfusion requirements and improve postoperative recovery. Larger multicentric studies are recommended for further validation.