Vaner KOKSAL, Tolga MERCANTEPE, Levent TUMKAYA
Turkish Neurosurgery - 2026;36(2):229-236
AIM: To compare haemostasis induced with tranexamic acid (TXA) and immunosuppression induced with infliximab (INF) as strategies to reduce epidural fibrosis (EF) in rat laminectomy model. MATERIAL and METHODS: Twenty-one male Sprague-Dawley rats were randomly assigned into control group (no treatment), TXA treatment group and INF treatment group (n=7 per group). TXA (10-20 mg/mL) and INF (1 mg/mL) were topically applied following L1-L3 laminectomy. Histopathological evaluation involving haematoxylin-eosin and Masson-Goldner's Trichrome staining was conducted eight weeks postoperatively. EF severity, fibroblast density, inflammatory cell infiltration and neovascularisation were analysed. RESULTS: Histopathological analysis showed that fibrosis scores were significantly lower in the TXA treatment group than in the control and INF treatment groups (p<0.05). Moreover, TXA reduced fibroblast proliferation, inflammatory cell infiltration and collagen deposition. While INF exhibited moderate anti-fibrotic effects, it was less effective than TXA. No systemic side effects were observed in either treatment group. CONCLUSION: This study demonstrates that TXA prevents EF more effectively than INF following laminectomy. The findings also underscore that TXA is superior over INF in reducing EF . These results suggest that compared with INF-induced immunosuppression, TXA-induced haemostasis is the more effective strategy to minimise postoperative fibrosis in spinal surgery.
