Objective To investigate the safety and efficacy of different doses of tranexamic acid (TXA) in posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion by a prospective clinical study. Methods The middle-aged and elderly patients with cervical spondylotic myelopathy, who were admitted between January 2020 and January 2022 and scheduled to undergo posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion, were studied as the research subjects. Among them, 165 patients met the selection criteria and were included in the study. The patients were allocated into 3 groups (n=55) by random double-blind lottery. Groups A and B were given intravenous infusion of TXA at 30 minutes before operation according to the standards of 15 and 30 mg/kg, respectively; and group C was given normal saline in the same way. There was no significant difference in gender, age, body mass index, and preoperative D-dimer, hemoglobin (Hb), and hematocrit (HCT) between groups (P>0.05). The intraoperative bleeding, intraoperative blood transfusion, postoperative drainage volume, drainage days, and postoperative hospital stay were recorded. The Hb, HCT, and D-dimer were compared before operation and at 3 days after operation. Venous ultrasonography of the lower extremities was taken after operation to assess thrombosis; and the postoperative hematoma and epilepsy were also observed. Results All operations were successfully completed, and the incisions healed by first intention. The differences in intraoperative bleeding volume, postoperative drainage volume, drainage days, and postoperative hospital stay between groups were significant (P<0.05). The above indexes were significantly less in group B than in groups A and C. During operation, 14 patients in group A and 23 patients in group C were transfused, and no patient in group B had blood transfusions. Compared with groups A and C, the blood transfusion volume in group B significantly decreased (P<0.05), and the difference between groups A and C was not significant (P>0.05). There was no significant difference in the differences of D-dimer, Hb, and HCT before and after operation between groups (P>0.05). At 5 days after operation, the venous ultrasonography of the lower extremities showed that the 2 cases of intermuscular venous thrombosis occurred in groups A, B, and C, respectively. No hematoma or epilepsy occurred after operation. Conclusion The application of 15 and 30 mg/kg TXA in posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion can reduce intraoperative bleeding and postoperative drainage volume, postoperative drainage days, and postoperative hospital stay. And application of 30 mg/kg TXA can reduce intraoperative blood transfusion, without increasing the risk of lower extremity venous thrombosis, hematoma, and epilepsy.
Objective To investigate the effect of the opening side selection in unilateral open-door laminoplasty (UODL) on postoperative outcomes for patients with cervical ossification of the posterior longitudinal ligament (OPLL) presenting with symptom-ossification mismatch. Methods A retrospective analysis was conducted on 89 patients with multilevel cervical OPLL presenting with symptom-ossification mismatch treated between January 2020 and January 2024. According to the opening side, 41 patients underwent laminoplasty with the opening toward the side with more severe ossification (ipsilateral group), and 48 patients toward the side with more severe symptoms and signs (contralateral group). There was no significant difference in the baseline data between groups (P>0.05), including gender, age, body mass index, disease duration, comorbidities, number and type of affected segment, and preoperative visual analogue scale (VAS) score, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, ossification length, ossification area, sagittal and coronal canal diameter, Pavlov ratio, C2-7 Cobb angle, and spinal cord diameter ratio. Perioperative parameters, changes in VAS score, NDI and JOA score, radiological parameters, and postoperative complications were analyzed. Results There was no significant difference between groups in operation time, intraoperative blood loss, or length of hospital stay (P>0.05). All patients were followed up 11-30 months (mean, 19.3 months). At last follow-up, VAS score and NDI significantly decreased and JOA score significantly increased when compared with preoperative values in both groups (P<0.05), while the changes in these clinical scores were not significantly different between the two groups (P>0.05). Radiological evaluation showed that there was no significant difference between groups in the changes of ossification length and C2-7 Cobb angle, nor in postoperative opening width and opening angle (P>0.05). However, the change in spinal cord diameter ratio differed significantly between groups (P<0.05). At last follow-up, the spinal cord posterior shift distance in the ipsilateral group was significantly more than that in the contralateral group (P<0.05). There was no significant difference between groups in the incidences of C5 nerve root palsy, axial symptoms, or the overall complications (P>0.05). Conclusion For patients with multilevel cervical OPLL with symptom-ossification mismatch, UODL provides similar improvement in clinical symptoms regardless of whether the opening side is directed toward the side with more severe ossification or toward the more symptomatic side. However, opening toward the side with more severe ossification may lead to more pronounced spinal cord morphological recovery and posterior shift, although the impact of this radiological advantage on long-term clinical outcomes requires further investigation.
