Is Tranexamic Acid an Effective Prevention in the Formation of Epidural Fibrosis? Histological Evaluation in the Rats.

OBJECTIVE: The present study aimed to determine the topical and systemic efficacy of tranexamic acid (TXA) on epidural fibrosis in a rat laminectomy model. METHODS: Thirty-two 12-month-old adult Sprague-Dawley rats were used in this study. Each rat underwent bilateral laminectomy at the L1 and L2 vertebral levels. Rats were divided into four groups : in group I (control group, n=8), a laminectomy was performed and saline solution was applied into the surgical space. In group II (topical group, n=8), laminectomy was performed and 30 mg/ kg TXA was applied to the surgical site before skin closure. In group III (systemic group, n=8), 30 mg/kg TXA was administered intravenously via the tail vein in the same session as the surgical procedure. In group IV (topical and systemic group, n=8), TXA was administered 30 mg/kg both topical and intravenous. The rats were sacrificed at 4 weeks postoperatively. Masson's trichrome and hematoxylin and eosin were used to assess acute inflammatory cells, chronic inflammatory cells, vascular proliferation, and epidural fibrosis. RESULTS: Epidural fibrosis, acute inflammation, chronic inflammation, and sum histologic score value were significantly lower in the systemic TXA group, systemic and topical TXA groups than in the control group (p<0.05). In addion, the sum histologic score was significantly lower in the topical TXA group than in the control group (p<0.05). CONCLUSION: In this study, epidural fibrosis formation was prevented more by systemic application, but the topical application was found to be effective when compared to the control group. As a result, we recommend the systemic and topical use of TXA to prevent epidural fibrosis during spinal surgery.

The Effects of the Use of Single-Screw Plates (Univertebral Screw Plates) versus Double-Screw Plates (Bivertebral Screw Plates) on Fusion After One-Level or Two-Level Anterior Cervical Discectomy and Fusion.

OBJECTIVE: In this study, we aimed to retrospectively analyze the effects of the use of univertebral screw plates (USPs) and bivertebral screw plates (BSPs) on fusion in patients who underwent anterior cervical discectomy and fusion (ACDF). METHODS: Forty-two patients who were treated with USPs or BSPs after 1-level or 2-level ACDF and had a minimum follow-up period of 2 years were included in the study. Fusion and the global cervical lordosis angle were evaluated using direct radiographs and computed tomography images of the patients. The clinical outcomes were assessed using the Neck Disability Index and visual analog scale. RESULTS: Seventeen patients were treated using USPs and 25 patients using BSPs. Fusion was achieved in all patients who underwent BSP fixation (1-level ACDF, 15 patients; 2-level ACDF, 10 patients) and 16 of the 17 patients who underwent USP fixation (1-level ACDF, 11 patients; 2-level ACDF, 6 patients). The plate of the patient with fixation failure had to be removed because it was symptomatic. A statistically significant improvement was observed in the immediate postoperative period and at the last follow-up in terms of global cervical lordosis angle, visual analog scale score, and Neck Disability Index of all patients who underwent 1-level or 2-level ACDF surgery (P < 0.05) CONCLUSIONS: Although USPs are less costly and easier to implant, the effect of USPs and BSPs on fusion and clinical outcomes is similar. Thus, surgeons may prefer to use USPs after 1-level or 2-level ACDF.

Comparison of early clinical results and re-tear rates of transosseous-equivalent rotator cuff repairs with or without medial knots.

OBJECTIVES: This study aims to compare the clinical results and repair integrity of two of the commonly used transosseous-equivalent arthroscopic rotator cuff repair techniques, which are the knotless and the medial knotted suture bridge, for patients with full-thickness medium to large-sized rotator cuff tears. PATIENTS AND METHODS: The study included 121 patients (55 males, 66 females; mean age 56.7±7.3 years; range, 39 to 72 years) with cuff tears. In total, 64 shoulders were operated on using the conventional medial knotted suture bridge technique (group A) and 57 shoulders were operated on using the knotless suture bridge technique (group B). The Constant score, visual analog scale (VAS) and active forward flexion angle were assessed preoperatively and after a minimum of 12 months postoperatively. Postoperative rotator cuff integrity was evaluated by magnetic resonance imaging (MRI) after a mean of 19±4.7 months. RESULTS: There were no significant differences between the groups in terms of age, gender, body mass index, and anteroposterior extension of the tear on the sagittal MRIs. Postoperatively, the mean Constant score increased from 32.3±8.5 points to 84±11.6 points in group A and from 31.3±9.3 points to 86.4±8.7 points in group B (p<0.001), while the mean VAS score decreased from 6.0±1.0 to 1.3±1.2 in group A and from 6.4±1.0 to 1.0±0.8 in group B (p<0.001). According to the control MRIs, the re-tear rate was 10.9% (n=7) in group A and 8.8% (n=5) in group B. No statistically significant difference was found in either the clinical scores or re-tear rates between the groups (p>0.05). CONCLUSION: In comparison to the medial knotted technique, less time-consuming and simpler knotless technique provides similar satisfactory outcomes after a minimum of one year postoperatively.