Ginsenoside Rg1 relieves rat intervertebral disc degeneration and inhibits IL-1ß-induced nucleus pulposus cell apoptosis and inflammation via NF-κB signaling pathway.

The study aimed to investigate the effect of ginsenoside Rg1 on intervertebral disc degeneration (IVDD) in rats and IL-1ß-induced nucleus pulposus (NP) cells, and explore its underlying mechanism. Forty IVDD rat models were divided into the IVDD group, low-dose (L-Rg1) group (intraperitoneal injection of 20 mg/kg/d ginsenoside Rg1), medium-dose (M-Rg1) group (intraperitoneal injection of 40 mg/kg/d ginsenoside Rg1), and high-dose (H-Rg1) group (intraperitoneal injection of 80 mg/kg/d ginsenoside Rg1). The pathological change was observed by HE and safranin O-fast green staining. The expression of IL-1ß, IL-6, TNF-α, MMP3, aggrecan, and collagen II was detected. The expression of NF-κB p65 in IVD tissues was detected. Rat NP cells were induced by IL-1ß to simulate IVDD environment and divided into the control group, IL-1ß group, and 20, 50, and 100 µmol/L Rg1 groups. The cell proliferation activity, the apoptosis, and the expression of IL-6, TNF-α, MMP3, aggrecan, collagen II, and NF-κB pathway-related protein were detected. In IVDD rats, ginsenoside Rg1 improved the pathology of IVD tissues; suppressed the expression of IL-1ß, IL-6, TNF-α, aggrecan, and collagen II; and inhibited the expression of p-p65/p65 and nuclear translocation of p65, to alleviate the IVDD progression. In the IL-1ß-induced NP cells, ginsenoside Rg1 also improved the cell proliferation and inhibited the apoptosis and the expression of IL-6, TNF-α, aggrecan, collagen II, p-p65/p65, and IκK in a dose-dependent manner. Ginsenoside Rg1 alleviated IVDD in rats and inhibited apoptosis, inflammatory response, and ECM degradation in IL-1ß-induced NP cells. And Rg1 may exert its effect via inhibiting the activation of NF-κB signaling pathway.

FOXO3-Activated HOTTIP Sequesters miR-615-3p away from COL2A1 to Mitigate Intervertebral Disc Degeneration.

In this study, knockout of FOXO3 was found to impair intervertebral disc maturation and homeostasis in postnatal mice as well as facilitating extracellular matrix degradation. RNA sequencing can uncover disease-related gene expression and investigate disease pathophysiology. High-throughput transcriptome sequencing and experimental validations were used to identify the essential gene and mechanism involved in intervertebral disc degeneration (IDD). Nucleus pulposus (NP) tissue samples were collected from the mice with conditional knockout of FOXO3 (FOXO3 KO) for high-throughput sequencing, followed by screening of differentially expressed lncRNAs and mRNAs. The mRNAs were subjected to GO and KEGG enrichment analyses. Interactions among FOXO3, HOTTIP, miR-615-3p, and COL2A1 were analyzed. NP cells were subjected to a series of mimics, inhibitors, overexpression plasmids, and shRNAs to validate the mechanisms of FOXO3 in controlling HOTTIP/miR-615-3p/COL2A1 in IDD. Mechanistically, FOXO3 transcriptionally activated HOTTIP, facilitated the competitive HOTTIP binding to miR-615-3p, and increased the expression of the miR-615-3p target gene COL2A1. Thus, NP cell proliferation was induced, cell apoptosis was diminished, resulting in delayed development of IDD. Based on these data, the transcription factor FOXO3 may decrease miR-615-3p binding to COL2A1 and up-regulate COL2A1 expression by activating HOTTIP transcription, which in turn inhibits NP cell apoptosis and promotes its proliferation, to prevent the degradation of intervertebral disc matrix and maintain the normal physiological function of intervertebral disc, thereby preventing the occurrence and development of IDD.

Clinical Efficacy of Bilateral Decompression Using Biportal Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases.

OBJECTIVE: The study purpose was to compare unilateral biportal endoscopic lumbar interbody fusion (ULIF) with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative diseases in terms of surgical trauma and short-to medium-term postoperative results. METHODS: Forty-nine patients with lumbar degenerative diseases (25 underwent ULIF, 24 underwent MIS-TLIF) who were treated between May 2019 and October 2021, were included in this retrospective analysis. We compared the 2 groups' blood loss, serum C-reactive protein (CRP), visual analog scale (VAS) scores for low back and leg pain, and the Oswestry Disability Index (ODI) score and slip percentage (SP). The modified Macnab score was obtained at the last follow-up. RESULTS: On the postoperative day, the CRP levels (P < 0.05) were considerably lower in the ULIF group than those in the MIS-TLIF group. In addition, the ULIF group had significantly decreased intraoperative blood loss (P = 0.00) and postoperative blood loss (P = 0.00). After surgery, there was significant improvement in both groups in the VAS scores for low back and leg pain and in the ODI scores (P < 0.05). Two weeks after surgery, the ODI and VAS scores for low back pain of the ULIF group were considerably lower than those of the MIS-TLIF group (P < 0.05). The excellent and good rates of the Macnab criteria between the 2 groups were not significantly different at the last follow-up (P = 0.95). CONCLUSIONS: The ULIF technique can effectively treat short-segment lumbar degenerative diseases and is a feasible alternative to the traditional minimally invasive surgery.

Modified facet joint fusion for multilevel lumbar spinal stenosis: a retrospective study of 135 consecutive patients.

OBJECTIVE: To evaluate the safety and efficacy of modified facet joint fusion (MFF) for the treatment of multilevel (three-level or more) lumbar spinal stenosis (LSS). PATIENTS AND METHODS: In this retrospective study, 135 consecutive patients who underwent initial MFF for multilevel LSS were included. Clinical outcomes included fusion rate, change of visual analogue scale pain scores for low back pain (VAS-LBP) and leg pain (VAS-LP), Japanese Orthopedic Association scores (JOA), Oswestry Disability Index (ODI) and MacNab classification before and after MFF. The complications were also analyzed. RESULTS: The fusion rates were 46.7% (63/135) at 6-month and 89.6% (121/135) at 1-year. The mean VAS-LBP, VAS-LP, and ODI significantly decreased from 5.2 ± 0.6, 5.7 ± 0.8 and 65 ± 7.9 to 1.58 ± 0.4, 0.58 ± 0.3 and 20.8 ± 5.8, respectively (all p < 0.001). The mean JOA markedly improved from 10.0 ± 1.3 to 26.1 ± 1.5 (p < 0.001). Excellent/good results of MacNab classification were achieved in 88.9% (120/135) of the patients. The overall rate of complications after MFF was 5.9%, including poor wound healing (2.2%), calf muscular venous thrombosis (0.74%), deep venous thrombosis (0.74%), superficial wound infection (1.48%), transient foot drop (0.74%). All the complications were transient and improved without prolonged hospital stay and sequelae. CONCLUSION: MFF may be safe and efficient for multilevel LSS with high fusion rate and significant symptom relief, which is worthy of further study.

p300 arrests intervertebral disc degeneration by regulating the FOXO3/Sirt1/Wnt/ß-catenin axis.

The transcription factor p300 is reportedly involved in age-associated human diseases, including intervertebral disc degeneration (IDD). In this study, we investigate the potential role and pathophysiological mechanism of p300 in IDD. Clinical tissue samples were collected from patients with lumbar disc herniation (LDH), in which the expression of p300, forkhead box O3 (FOXO3), and sirtuin 1 (Sirt1) was determined. Nucleus pulposus cells (NPCs) isolated from clinical degenerative intervertebral disc (IVD) tissues were introduced with oe-p300, oe-FOXO3, Wnt/ß-catenin agonist 1, C646 (p300/CBP inhibitor), or si-p300 to explore the functional role of p300 in IDD and to characterize the relationship between p300 and the FOXO3/Sirt1/Wnt/ß-catenin pathway. Also, we established a rat IDD model by inducing needle puncture injuries in the caudal IVDs for further verification of p300 functional role. We found that p300 was downregulated in the clinical tissues and NPCs of IDD. Overexpression of p300 promoted the proliferation and autophagy of NPCs while inhibiting cell apoptosis, which was associated with FOXO3 upregulation. p300 could increase the expression of FOXO3 by binding to the Sirt1 promoter, and thus, contributed to inactivation of the Wnt/ß-catenin pathway. In vivo results further displayed that p300 slowed down the progression of IDD by disrupting the Wnt/ß-catenin pathway through the FOXO3/Sirt1 axis. Taken together, we suggest that p300 can act to suppress IDD via a FOXO3-dependent mechanism, highlighting a potential novel target for treatment of IDD.

Prognostic factors of chondroblastic osteosarcoma and nomogram development for prediction: A population-based, STROBE-compliant study.

ABSTRACT: The present study aimed to develop nomograms to predict survival in patients with chondroblastic osteosarcoma (COS).An analysis was conducted of 320 cases of COS collected from the surveillance, epidemiology, and end results (SEER) database between 2004 and 2015. Independent prognostic factors were screened using univariate and multivariate Cox analyses. Subsequently, nomograms were established to predict the patients' cancer-specific survival (CSS) and overall survival (OS) rates. The prediction accuracy and discriminative ability of the nomograms were examined using calibration curves and the concordance index (C-index).As revealed in the univariate and multivariate Cox regression analysis, age, tumor size, the primary site, the presence of metastasis, a history of having undergone surgery, and a history of having received radiotherapy were found to be independent prognostic factors associated with survival in patients with COS (all P < .05). Furthermore, age >39 years, the presence of distant metastasis, no history of having undergone any surgery, and tumor size >103 mm were found to be associated with poor prognosis in patients, while the primary site of the mandible and no history of having undergone radiotherapy showed associations with a more favorable prognosis in patients. Next, nomograms were constructed to predict the OS and CSS in patients with COS.We constructed nomograms that can provide accurate survival predictions in patients with chondroblastic osteosarcoma. These nomograms can help surgeons customize the treatment strategies for patients with chondroblastic osteosarcoma.

Clinical therapeutic effects of combined methotrexate and other chemotherapeutic agents in treating children and young patients with osteosarcoma: A protocol for systematic review and meta-analysis.

BACKGROUND: Osteosarcoma is one of the most common primary bone tumour in children and young patients, and the third most common among adults. Its main treatment option is currently based on neoadjuvant or adjuvant chemoradiotherapy along with the lesion's surgical resection. The current study's primary aim is to examine the clinical therapeutic impacts of combined methotrexate, along with other chemotherapeutic agents to treat children and young adults suffering from osteosarcoma. METHODS: We will perform a comprehensive literature search in English database (PubMed, EMBASE, Cochran Library CINAHL, and PsycINFO) and Chinese database (Chinese National Knowledge Infrastructure, VIP information database, Chinese Biomedical Database, and WanFang Database) with no language restriction from their inception to the search date. Additionally, two independent authors will screen the works of literature obtained from these databases, obtain information, and examine the risks of data included for the studies' bias. Furthermore, we intend to employ the Q statistics as well as I2 statistics to calculate heterogeneity among each study's analysis. Accordingly, we will utilize the funnel plots and Egger test to assess the possibility of publication bias where relevant. RESULTS: The current study aims to provide significant information regarding the clinical therapeutic impacts of combines methotrexate along with other chemotherapeutic agents to treat children and young adults suffering from osteosarcoma. CONCLUSIONS: The present study will generate compelling evidence of combined methotrexate as well as other chemotherapeutic agents for osteosarcoma among children and young adults. Also, it will provide clinical practice suggestions. ETHICS AND DISSEMINATION: The study is founded upon published data. Therefore, there is no requirement for ethics approval. OSF REGISTRATION NUMBER: March 26, 2021.osf.io/a23rc. (https://osf.io/a23rc/).

Knockdown of MCM8 functions as a strategy to inhibit the development and progression of osteosarcoma through regulating CTGF.

Osteosarcoma is the most common primary malignant tumor of bone derived from osteoblasts, which is a noteworthy threat to the health of children and adolescents. In this study, we found that MCM8 has significantly higher expression level in osteosarcoma tissues in comparison with normal tissues, which was also correlated with more advanced tumor grade and pathological stage. In agreement with the role of MCM proteins as indicators of cell proliferation, knockdown/overexpression of MCM8 inhibited/promoted osteosarcoma cell proliferation in vitro and tumor growth in vivo. Also, MCM8 knockdown/overexpression was also significantly associated with the promotion/inhibition of cell apoptosis and suppression/promotion of cell migration. More importantly, mechanistic study identified CTGF as a potential downstream target of MCM8, silencing of which could enhance the regulatory effects of MCM8 knockdown and alleviate the effects of MCM8 overexpression on osteosarcoma development. In summary, MCM8/CTGF axis was revealed as critical participant in the development and progression of osteosarcoma and MCM8 may be a promising therapeutic target for osteosarcoma treatment.

Lumbar spinal stenosis combined with obesity-induced idiopathic spinal epidural lipomatosis treated with posterior lumbar fusion: case report.

BACKGROUND: Spinal epidural lipomatosis is a rare cause of lumbar spinal stenosis. While conservative therapy is applicable for most of cases, surgical intervention is necessary for severe ones. This is the first time we apply this modified technique to this disease. CASE PRESENTATION: The case is a 53-year-old man. He is 175 cm tall and weighs 102 kg (body mass index 33.3 kg/cm2), presenting with low back pain and bilateral legs pain and numbness. Radiological examination showed severe lumbar spinal stenosis resulting from adipose hyperplasia, combined with hyperosteogeny and hypertrophy of ligaments, which are common etiological factors. Posterior decompression, internal fixation and a modified articular fusion technique was performed on this patient, and regular follow-up that up o 22 months showed outstanding clinical outcomes. CONCLUSIONS: A suitable style of posterior lumbar fusion should be considered to especially severe case with lumbar spinal stenosis and idiopathic spinal epidural lipomatosis.

Modified Facet Joint Fusion for Lumbar Degenerative Disease: Case Series of a Fusion Technique, Clinical Outcomes, and Fusion Rate in 491 Patients.

BACKGROUND: Controversy still exists regarding the optimal fusion technique for the treatment of unstable lumbar spondylolisthesis. OBJECTIVE: To evaluate the safety and efficacy of modified facet joint fusion (MFF). METHODS: A total of 491 patients with unstable lumbar spondylolisthesis who underwent MFF were retrospectively reviewed. Computed tomography was used to evaluate the fusion rate of MFF at 6- and 12-mo follow-up postoperatively. Clinical outcomes included visual analog scale pain scores for low back pain (VAS-LBP) and leg pain (VAS-LP), Japanese Orthopedic Association scores (JOA), and Oswestry Disability Index (ODI), all of which were obtained preoperatively and postoperatively at 1-, 3-, 6-, and 12-mo follow-up times. The clinical outcomes were determined to be excellent, good, fair, or poor according to the MacNab classification at the last follow-up time. RESULTS: Of the 491 patients, the fusion rates at the 6-mo and 1-yr follow-up were 56.8% and 96.1%, respectively. Between baseline and 1-yr follow-up time, VAS-LP and VAS-LBP improved from 5.6 ± 0.9 to 0.4 ± 0.5 and 5.1 ± 1.2 to 1.5 ± 0.9, respectively (P < .001). JOA improved from 9.0 ± 2.0 to 27.7 ± 1.0, and ODI decreased from 64.0 ± 2.0 to 19 ± 1.0 (P < .001). At the final evaluation, 93.6% patients showed excellent or good results, and 3.2% showed fair results. There were no MFF technique-related complications. CONCLUSION: MFF technique achieved satisfactory clinical outcomes and fusion rate and appears to be a promising alternative fusion technique for the treatment of unstable lumbar spondylolisthesis.

Tranexamic acid reduce hidden blood loss in posterior lumbar interbody fusion (PLIF) surgery.

BACKGROUND: Posterior lumbar interbody fusion (PLIF) surgery is associated with significant blood loss; however, few studies have focused on hidden blood loss (HBL) in PLIF or its regulatory factors. The purpose of this study was to explore the HBL in PLIF surgery as well as the influence of tranexamic acid (TXA) on blood loss in PLIF. METHODS: We performed a randomized controlled trial (RCT) and recruited patients undergoing PLIF into the study from November 2013 to April 2017. All participants were assigned to one of 2 groups according to a simple equal probability randomization scheme. At the end of PLIF surgery, for patients in the TXA group, the surgical field was immersed in TXA (1 g in 100 mL of saline solution) for 5 min before stitching the wound. For the control group, the surgical field was immersed in the same volume of normal saline. RESULTS: In our study, the drainage volume during the first 24 h and the total postoperative drainage volume were significantly lower in patients in the TXA group than in the control group (P = .001). The hematocrit (Hct) of the drainage and calculation of blood contained in the drainage showed similar results. The mean length of hospital stay and rate of blood transfusion in the TXA group were less than those in the control group (P < .05). HBL was responsible for 45.6% of the total blood loss in PLIF, and both of the indicators in the TXA group were much lower than those in the control group. CONCLUSIONS: PLIF is associated with massive perioperative HBL, but the application of topical TXA leads to less postoperative blood loss including less HBL, a lower blood product transfusion rate, and a shorter hospital stay for PLIF.

Local infiltration with cocktail analgesics during 2 level lumbar spinal fusion surgery: Study protocol of a randomized controlled trial.

BACKGROUND: Despite introducing novel analgesics, pain management for spine surgery remains a challenge. Multimodal pain control has recently gained popularity in surgical spine care. We proposed a novel management approach using multimodal cocktail analgesics. Injection to skin surrounding surgical incision site will be given perioperatively. This study evaluates the safety and efficacy of cocktail analgesic injection on pain management following lumbar spinal fusion surgery. METHODS: Thirty-six patients with degenerative lumbar spinal diseases on the waiting list for lumbar spinal fusion surgery will be recruited. Patients will be randomly assigned to receive either cocktail analgesic injection or sterile saline before surgical wound closure. All patients will routinely receive postoperative intravenous patient-controlled analgesia (IV-PCA) with sufentanil on an as-needed basis without a basal dose. The primary outcome is perceived pain intensity as measured by visual analog pain score. Secondary outcomes include sufentanil consumption, time to first use of IV-PCA, rescue analgesics consumption, and the presence of adverse effects. Findings of this interventional trial will provide novel evidence supporting the superior effect of cocktail analgesic injection during surgery. TRIAL REGISTRATION NUMBER: ChiCTR-IPR-17013094.

Small incision discectomy for lumbar disc herniation in 98 patients with 5-year follow-up: A retrospective case series study.

Optimal surgical technique to treat lumbar disc herniation (LDH) remains controversial. We described a small incision discectomy technique (SID), and to evaluate its safety and efficacy. A retrospective study involving 98 consecutive patients with LDH managed by SID was conducted. All patients were followed up for 5 years. Outcomes included visual analogue scale (VAS), Japanese Orthopedic Association (JOA), operative time, length of incision, blood loss, hospital stay, hospitalization costs, x-ray exposure, reoperation, and complications. The results were determined to be excellent, good, fair, or poor according to the MacNab classification. All patients completed the 5-year follow-up. Relative to preoperative scores, VAS and JOA were both significantly improved. As a whole, 93.8% (92/98) patients showed excellent or good results, 3.1% (3/98) fair, and 3.1% (92/98) poor. The operation time, length of incision, blood loss, and hospital stay were 50 ±â€Š11.1 minutes, 2.2 ±â€Š0.3 cm, 35 ±â€Š3.5 mL, and 4.3 ±â€Š0.2 days, respectively. Additionally, compared with previous literature reports, the hospitalization costs and x-ray exposure were apparently less. The reoperation and recurrence rate were 3.2% and 2.1%. No complications were observed. From these data we conclude that SID appears to be a safe, cost-effective technique for LDH, and has lower x-rays exposure time when compared with literature of percutaneous endoscopic lumbar discectomy (PELD).

Tranexamic Acid in Reducing Gross Hemorrhage and Transfusions of Spine Surgeries (TARGETS): study protocol for a prospective, randomized, double-blind, non-inferiority trial.

BACKGROUND: Tranexamic acid (TXA) has been routinely delivered in multisegmental spinal decompression and bone graft fusion surgeries with satisfactory outcomes in minimizing gross blood loss and transfusion demands. However, concerns remain that intravenously delivered TXA (ivTXA) may increase risks of postoperative convulsive seizures and systemic thrombogenicity. Topical use of TXA (tTXA), being more targeted to the surgical bleeding site while minimizing patient systemic exposure to ivTXA, has been successfully applied to attenuate blood losses and transfusion requirements in hip and knee arthroplasty. Yet, randomized controlled trials on tTXA efficacy and safety are still lacking in spinal surgeries. With this knowledge gap, we hypothesize that tTXA exhibits non-inferiority to ivTXA in blood conservation and clinical safety in multisegmental spinal decompression and bone graft fusion surgeries. METHODS: A prospective, randomized, double-blind, non-inferiority study design will be adopted. The target sample size is 176. Eligible patients will be randomly allocated to receive either ivTXA or tTXA treatment. The primary end point is the perioperative total blood loss. Secondary end points consist of visible blood losses (intraoperative, postoperative 0-24 h, postoperative 0-48 h, combined perioperative blood loss, total postoperative blood loss), postoperative hidden blood loss, plasma TXA levels, postoperative conventional coagulation monitoring (prothrombin time, activated partial thromboplastin time, fiber Bragg grating, international normalized ratio), postoperative thromboelastography monitoring (reaction time, clot formation time, clot strength, fibrinolysis), postoperative hemoglobin nadir (within postoperative 48 h), perioperative transfusion amounts and rates, and length of hospital stay. Safety end points will be monitored too. DISCUSSION: This proposed study will contribute to expanding clinical evidences of tTXA for bleeding management in major spinal surgeries. This will be a high-quality prospective randomized trial with sufficient sample size, strict methodology, and few design deficits. It will investigate the potentiality of tTXA as an alternative to ivTXA in improving the current standard of care in multisegmental spinal surgeries, thereby optimizing the enhanced recovery after surgery scheme in spinal surgeries. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03011866 . Registered on 5 January 2017.

Perioperative Measurement of Radiation Exposure to Radiation-Sensitive Organs of Patients Undergoing Lumbar Surgeries Using a Thermoluminescent Dosimeter.

OBJECTIVE: To introduce a method of accurately measuring the equivalent dose received by radiation-sensitive organs using the thermoluminescent dosimeter (TLD) and to provide reference values for future studies associated with radiation protection in patients undergoing lumbar spine surgeries. METHODS: After careful selection and preparation, TLD chips were used to obtain measurements from the eyes, thyroid glands, breasts, and gonads of 20 patients undergoing lumbar spine surgeries. The results were obtained via air kerma conversion-related calculations. RESULTS: The overall radiation exposures absorbed perioperatively by the eyes, thyroid glands, right breasts, left breasts, right ovaries, left ovaries, and testes were 0.41 ± 0.13, 1.43 ± 0.45, 6.95 ± 3.63, 9.50 ± 6.14, 29.86 ± 28.62, 23.47 ± 22.10, and 5.41 ± 1.86 mSv, respectively. A single computed tomography (CT) scan contributed to more than 75% of the overall dose received regardless of the position used. CONCLUSIONS: Patients received significantly higher radiation doses from CT scans than from regular digital radiograph examinations. These radiation doses were concentrated in the regional area of scanning. Our results indicate the necessity and benefits of radiation protection measures, especially for the organs researched herein, when patients undergoing lumbar surgeries require radiographic diagnostic examinations.

Can tranexamic acid conserve blood and save operative time in spinal surgeries? A meta-analysis.

BACKGROUND CONTEXT: It is widely accepted that tranexamic acid (TXA) effectively reduces blood losses and transfusions in major surgeries. However, limited studies investigated the role of TXA in conserving blood and saving operative time in spine surgeries. PURPOSE: This meta-analysis was conducted to gather scientific evidence for TXA efficacy on conserving blood and saving operative time in spine surgeries. STUDY DESIGN: A meta-analysis was performed. PATIENT SAMPLE: Eighteen RCTs and 18 non-RCT studies involving 2,572 patients were included in the final analyses, comparing the effectiveness of intravenous TXA with a placebo/no treatment group. OUTCOME MEASURES: Outcomes of interest included intraoperative, postoperative, and perioperative blood losses, allogeneic blood transfusion rates, cell salvage transfusion amounts, operative time, and the number of postoperative thrombosis events. METHODS: An exhaustive literature search was conducted in the MEDLINE and EMBASE databases from January 2000 through March 2017. Meta-analysis was performed using Review Manager (RevMan) version 5.0. For continuous outcomes, the means and standard deviations were pooled to a mean difference and 95% confidence interval (CI). Odds ratios (OR) and 95% CI were calculated for dichotomous outcomes. The quantity of heterogeneity was assessed using I2 statistics. When there was no statistical evidence of substantial heterogeneity (I2≤50%), a fixed-effect model was adopted; otherwise, a random-effect model was chosen. Subgroup analysis was performed when more than three studies were included on one issue, based on low or high the dose of TXA. Beijing Talent Fund (2016) was received to support this work. RESULTS: Significantly reduced intraoperative (weighted mean difference [WMD]=-280.09.00, p<.00001), postoperative (WMD=-120.15, p<.00001), perioperative (WMD=-310.86, p<.00001) blood losses, cell salvage transfusion amount (WMD=-471.79, p=.01), perioperative transfusion rate (odds ratio [OR], 0.33 [0.17, 0.65], p=.001), and operative time (WMD=-4.69, p=.003) were observed in TXA group. Furthermore, subgroup analysis revealed that high-dose TXA could reduce both intraoperative-perioperative allogeneic transfusion rates and operative time, whereas low dose of the drug does not convey such effects. CONCLUSIONS: With the most comprehensive literature inclusion up to the present, this meta-analysis suggests that intravenous TXA use constitutes an important measure for conserving blood and saving operative time in spinal surgeries. High-dose TXA significantly reduces intraoperative-perioperative allogeneic transfusion rates and operative time, whereas low-dose TXA does not convey such efficacies. Larger prospective trials are still required to define the optimal regimen and to confirm the safety of TXA use in such surgeries.

A randomized controlled trial on the effects of collagen sponge and topical tranexamic acid in posterior spinal fusion surgeries.

BACKGROUND: This is a randomized controlled trial research to assess the hemostatic efficacy of gelatin sponge, collagen sponge, and topical use of tranexamic acid (TXA) on postoperative blood loss in posterior spinal fusion surgeries. METHODS: We recruited patients with spinal degenerative diseases into the study from November 2013 to October 2016. All the participants were assigned to 3 groups using a simple, equal-probability randomization scheme: group A is a control group utilizing gelatin sponge, while groups B and C are experimental groups, applying collagen hemostatic sponge and topical TXA respectively. Postoperative blood loss, rates of transfusion, and hospitalization were compared among the 3 groups. RESULTS: In our study, the volume of drainage and blood content in drainage on the first postoperative day (POD 1) of patients in the experimental groups were significantly less than those in the control group, as well as rates of transfusion and postoperative hospitalization (P < 0.05). When compared with the control group, the volume of drainage decreased by 22.7% in group B and 56.2% in group C, while the blood content in drainage decreased by 28.8 and 75% respectively. CONCLUSIONS: In this study, collagen and topical use of TXA have both proven to be effective and safe for patients undergoing posterior spinal fusion surgeries, while TXA has exhibited better efficacy. The total amount of perioperative blood loss reduced significantly without increasing incidence of related complications. TRIAL REGISTRATION: A randomized controlled trial for effects of collagen sponge and topical tranexamic acid in posterior lumbar fusion surgeries. ChiCTR-IIR-17010785.

Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: A retrospective study.

In spinal fusion surgery, total blood loss (TBL) is composed of visible blood loss from the surgical field and wound drainage, and hidden blood loss (HBL). Until now, no published studies exist reporting the effect of topical use of tranexamic acid (tTXA) on HBL in patients undergoing posterior lumbar spinal fusion surgery. This study aimed to explore the effect of tTXA on HBL during primary posterior lumbar spinal fusion surgery. Between September 2014 and September 2016, 100 adult patients (age > 18 years) with lumbar disc herniation or lumbar spinal stenosis undergoing primary posterior lumbar instrumented spinal fusions at 1 institution were divided into tTXA and control groups. The primary outcome was HBL. Secondary outcomes include TBL, intraoperative blood loss (IBL), postoperative blood loss (PBL), hemoglobin (HGB) levels on preoperative (Pre-op) and postoperatively (days 1-3, POD1, POD2, POD3, respectively), and amount of allogeneic blood transfusion. Complications occurring perioperatively until hospitalization discharge were also collected. In the tTXA group (n = 50 patients), wound surface was soaked with TXA (1 g in 100 mL saline solution) for 5 minutes before wound closure. For the control group (n = 50 patients), wound surface was soaked with the same volume of normal saline. There were no significant differences in demographics, surgical traits between the 2 groups. There were no significant differences in IBL or perioperative blood transfusion requirements between the 2 groups. However, in the tTXA group, TBL, PBL, and HBL were significantly lower than those in the control group (550 ± 268 vs 833 ±â€Š298 mL, 53.5 ±â€Š43.9 vs 136.7 ±â€Š87.9 mL, 356.7 ±â€Š254.8 vs 501.1 ±â€Š216.9 mL, P < .001, respectively). HGB levels were significantly higher in the tTXA group (P < .001) on POD1 and had a slower decline on POD2 and POD3 than the control group. No complications associated with TXA were observed. From these data, we conclude that tTXA can effectively reduce HBL, without significant complications in adult patients undergoing posterior lumbar spinal fusion surgery.

Efficacy and Safety of Topical Use of Tranexamic Acid in Reducing Blood Loss During Primary Lumbar Spinal Surgery: A Retrospective Case Control Study.

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: To compare postoperative blood loss, amount of allogeneic blood transfusion, removal time of drainage tube, length of hospital stay, and complications associated with tranexamic acid (TXA). SUMMARY OF BACKGROUND DATA: Spinal fusion surgery can be associated with significant blood loss. To the best of our knowledge, very few published studies exist reporting the effect of topical use of tranexamic acid (tTXA) on decreasing the blood loss in patients undergoing posterior lumbar spinal fusions. METHODS: We conducted a retrospective nonrandomized case-control study of 100 adults undergoing posterior lumbar spinal fusion surgery. In the tTXA group (n = 50), wound surface was soaked with TXA (1 g in 100 mL saline solution) for 5 minutes before wound closure. In the control group (n = 50), wound surface was soaked with the same volume of normal saline. The postoperative blood loss, removal time of drainage tube, amount of allogeneic blood transfusion, and length of hospital stay were compared between the two groups. And the complications of TXA were also collected. RESULTS: In the tTXA group, the postoperative blood loss, removal time of drainage tube, postoperative length of hospital stay were significantly lower than those in the control group (155.2 ±â€Š104.3 mL vs. 278.6 ±â€Š124.1 mL, 2.0 ±â€Š0.6 d vs. 2.4 ±â€Š0.5 d, 4.7 ±â€Š1.4 d vs. 5.6 ±â€Š2.3 d, P < 0.05, respectively). There was no significant difference in blood transfusion between two groups. No significant changes were noticed in terms of coagulation function, and no complications associated with TXA were observed. CONCLUSION: tTXA can significantly reduce postoperative blood loss, accelerate removal of drainage tube, shorten the duration of hospital stay, while not increasing the complication incidence in patients undergoing posterior lumbar spinal fusion surgery. LEVEL OF EVIDENCE: 3.

A randomized controlled trial on effects of different hemostatic sponges in posterior spinal fusion surgeries.

BACKGROUND: Spinal fusion surgery is associated with significant blood loss, which may result in potential clinical complications, it is necessary to take safe and effective measures to reduce blood loss in surgery. We perform this study to assess the impact of three different hemostatic materials on perioperative blood loss. METHODS: We performed a Randomized Controlled Trial research and recruited patients with lumbar disease into the study between November 2013 and March 2015. All the participants were randomly assigned to 3 groups using a simple equal probability randomization scheme: Group A (Stypro hemostatic sponge), Group B (Collagen hemostatic sponge) and Group C (gelatin sponge). We compared postoperative blood loss between these 3 groups. RESULTS: In our study, drainage volume in the first 24 h of patients in Group A and B is significantly smaller, as well as total postoperative volumes of drainage (p < 0.05) during their hospital stay. The drainage volumes in the second 24 h were similar in the 3 groups. We also found that the average drainage Hematocrit (HCT) reduced over time, the average HCT of drainage is 18.04% and 11.72% on the first day and on the second day respectively. CONCLUSIONS: Hemostatic collagen sponge demonstrated better hemostasis effects than gelatin sponge with lower volume of postoperative drainage volume and blood loss in posterior spinal fusion surgery. TRIAL REGISTRATION: The trial registration number (TRN) of the study is ISRCTN29254316 and date of registration is 25/10/2016. Our trial was registered retrospectively.