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. 2021 Oct 11;6(2):151-158.
doi: 10.22603/ssrr.2021-0113. eCollection 2022.

Effect of Local Tranexamic Acid on the Quality of Bone Healing in a Rat Spinal Fusion Model

Ertugrul Sahin  1 , Haluk Berk  2 , Sermin Ozkal  3 , Pembe Keskinoglu  4 , Pinar Balci  5 , Ali Balci  5
Affiliations

Effect of Local Tranexamic Acid on the Quality of Bone Healing in a Rat Spinal Fusion Model

Ertugrul Sahin et al. Spine Surg Relat Res. .

Abstract

Introduction: The use of the antifibrinolytic agent tranexamic acid has positive effects on bleeding control, but our knowledge is still limited regarding how fibrinolysis suppression changes the process of bone formation and the quality of bone. Because of the several side effects of systemic tranexamic acid, topical usage has been established in several procedures. This study aimed to investigate the effect of local tranexamic acid on vertebral fusion by using macroscopic, radiologic, and microscopic techniques. We also attempted to determine the safe dose range in case some doses had negative effects on fusion.

Methods: Twenty-eight Wistar albino rats underwent intertransverse fusion. All rats were randomized into four groups: groups treated with local tranexamic acid doses of 1 mg/kg (D1), 10 mg/kg (D10), and 100 mg/kg (D100) and the control group with no drug (D0). At the end of the eighth week, all rats were sacrificed for evaluation in terms of palpation, mammography, and histopathologic analysis.

Results: The manual palpation results presented with lower fusion rates in D10 and D100 groups than in the control group. Radiological examination results were significantly higher in the control group. The histopathologic examination revealed no significant differences between groups in the percent of new bone formation.

Conclusions: Our results showed that local administration of tranexamic acid reduced the quality and stability of fusion without a delay in bone formation. However, doses of 1 mg/kg did not reduce the stability in the palpation test. Our findings suggest that 1 mg/kg dose is a critical threshold above which tranexamic acid reduced the bone healing process of fusion and that surgeons should consider the doses of local tranexamic acid during surgery.

Keywords: Antifibrinolytic; Bone healing; Rat; Spinal fusion; Tranexamic acid.

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Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Placement of the bone grafts harvested from the posterior iliac wing to the intertransverse interval (the grafts are shown by arrows).
Figure 2.
Figure 2.
Radiological examination of the rats: (A) control group, (B) D1 group, (C) D10 group, and (D) D100 group. Arrows indicate a fusion mass in the intertransverse field.
Figure 3.
Figure 3.
Fusion rates in manual palpation examination for all groups.
Figure 4.
Figure 4.
Fusion rates in the radiographic examination for all groups.
Figure 5.
Figure 5.
Specimens showing the formation of bone, cartilage, and marrow tissue in the intertrabecular fields (H&E, 40×). (A) Specimen with 4 points for union. The blue arrow demonstrates the field of chondrogenic healing with the prominence of chondrocyte cells. Green arrows demonstrate trabecular bones, and hematopoietic cells become reorganized by gathering together. (B) Specimen with 3 points for union. The blue arrow demonstrates the field of chondrogenic healing with the prominence of chondrocyte cells. Black arrows indicate the new woven bone fields. The green arrow displays the fibrosis generated by the loose connective tissues in the irregular trabecular bone fields that have gathered together. (C) Specimen with 1 point for union. Irregular bone formation (black arrows) and connective tissue containing dense fibrosis in intertrabecular fields (this area is shown by the blue arrow) (H&E, 20×). Normal bone marrow containing hematopoietic cells (green arrow). (D) Specimen with 2 points for union. Blue arrows show dense cartilage tissue with chondrocytes. The area shown by the black arrow shows endochondral ossification, which is the beginning of bone formation.
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