Study DesignSingle-surgeon, single-center prospective study with prospective data collection.PurposeTo clinically evaluate muscle damage after open lumbar surgery and its relationship to functional activity and to validatethe improvement in function as indicated by improved Oswestry Disability Index (ODI) score despite muscle damage.Overview of LiteratureFew studies have analyzed the functional loss and recovery pattern of muscles after open lumbar surgery.MethodsThe study included 30 patients who underwent open lumbar spine fusion surgery at our institution between August 2013 and May 2015. Preoperatively and at 6 months postoperatively, the patients were subjected to functional, biochemical, electrophysiological, and radiological assessments as outpatients, and the results were compared.ResultsMean preoperative and 6-month postoperative values were as follows: creatine phosphokinase levels, 133.07±17.57 and 139±17.7 U/L (p <0.001); Visual Analog Scale scores for backache, 6.73±0.88 and 3.27±0.96 (p <0.001); and ODI scores, 41.6±5.51 and 22.4±4.48 (p <0.001), respectively. Preoperatively, electrophysiological studies showed that 20% of the patients had a polyphasic configuration whereas at 6 months postoperatively, all patients had polyphasic configuration (p <0.001). The mean cross-sectional area of the multifidus observed using magnetic resonance imaging (MRI) decreased from 742.67±76.62 mm2 preoperatively to 598.27±66.38 mm2 6 months postoperatively (p <0.001), with all the patients exhibiting grade 2 atrophy.ConclusionsOpen lumbar fusion surgery resulted in significant damage to the lumbar paraspinal muscles, as indicated by a reduction in the cross-sectional area of the multifidus by MRI and denervation of the multifidus demonstrated using electromyography. Nevertheless, the patients reported reduced back pain and improved quality of life, which may have been due to increased stability of the previously unstable lumbar spinal segment after the surgery.

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Background: Tranexamic acid is widely used to limit blood loss after Total Knee Replacement as has been proved by numerous studies. There are many studies in literature which have assessed the blood loss after knee replacement with and without the use of tourniquet, and with and without the use of tranexamic acid separately in the postoperative period. In our hospital, Knee replacements are being done only after application of tourniquet. This is the first study which has randomised patients into four groups and compared the difference in blood loss between immediate and delayed release of tourniquet with and without Tranexamic acid. Patients were assessed by the parameters of postoperative drain volume and haemoglobin levels at 48hours in all four groups. There was a significant statistical advantage to the patient in terms of reduced blood loss and need for postoperative blood transfusion in Group D patients compared to A and B. This significantly reduces morbidity, especially in cases who would significantly benefit while undergoing bilateral knee replacements in the same sitting under a single anaesthesia. Materials and methods: (The use of tourniquet limits blood loss during surgery, however it activates the fibrinolytic process. This causes more blood loss after surgery. Tranexamic acid, by virtue of its chemical properties, reduces postoperative blood loss. Delayed release of tourniquet also has the same effect to some extent. These factors and their effect on postoperative blood loss have been studied separately, but there is no study which combines these factors). In this prospective study, 60 consecutive patients undergoing primary TKR for primary osteoarthritis of Knee were operated under spinal anaesthesia, tourniquet was applied, and a suction drain inserted during closure in every case. Tourniquet was not released before closure, but only after closure and compression dressing was applied. (The factors of present time of release of drain, and the use of tranexamic acid postoperatively were randomised into groups as follows-The study population was allocated into 4 groups using closed envelope technique for randomization: Group 'A'-Immediate drain release after wound closure and release of tourniquet and no Tranexamic acid. Group 'B'-Delayed drain release (after one hour of wound closure and release of tourniquet) and no Tranexamic acid. Group 'C'-Immediate drain release and 10mg/kg Tranexamic acid was administered intravenously in immediate post-operative period. Group 'D'-Delayed drain release (after one hour of wound closure and release of tourniquet) and 10 mg/kg. Tranexamic acid was administered intravenously. The four groups were formed to evaluate extent of blood loss postoperatively to rationalise a protocol regarding timing of tourniquet release combined with the use of Intravenous Tranexamic acid which would significantly reduce blood loss after surgery as it is common to do bilateral knee replacements in the same sitting under a single anaesthesia. The study aimed to identify in which grou...