{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:24:47Z","timestamp":1787066687453,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T00:00:00Z","timestamp":1632268800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Intravenous tranexamic acid (TXA) has been administered to reduce intraoperative blood loss in scoliosis surgery. However, the therapeutic effect of TXA on spinal muscular atrophy (SMA) scoliosis surgery is not well demonstrated. Therefore, this study aimed to assess the efficacy of intravenous TXA in SMA scoliosis surgery. From December 1993 to August 2020, 30 SMA patients who underwent scoliosis surgery (posterior fusion with fusion level of thoracic second or third to pelvis) were retrospectively enrolled and divided into the TXA group and non-TXA (control) group, with 15 patients in each group. Survey parameters were the amount of blood loss, blood transfusion, crystalloid transfusion volume, intubation time, and associated pulmonary complications (including pneumonia, pulmonary edema, and pulmonary atelectasis). The TXA group had significantly lesser blood loss than the control group (p = 0.011). Compared with the control group, the TXA group had significantly lower blood transfusion (p &lt; 0.001), crystalloid volume (p = 0.041), and total transfusion volume (p = 0.005). In addition, the TXA group had fewer postoperative pulmonary complications, and patients with pulmonary complications were associated with a higher relative crystalloid volume and relative total transfusion volume (p = 0.003 and 0.022, respectively). In conclusion, TXA can be effective in reducing intraoperative blood loss and crystalloid fluid transfusions during scoliosis surgery in SMA patients, which may aid in reducing postoperative pulmonary complications.<\/jats:p>","DOI":"10.3390\/ijerph18199959","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T20:15:32Z","timestamp":1632514532000},"page":"9959","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Intravenous Tranexamic Acid Reduces Blood Loss and Transfusion Volume in Scoliosis Surgery for Spinal Muscular Atrophy: Results of a 20-Year Retrospective Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3458-9939","authenticated-orcid":false,"given":"Shih-Hsiang","family":"Chou","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"},{"name":"Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Yen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"},{"name":"Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1606-2444","authenticated-orcid":false,"given":"Meng-Huang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan"},{"name":"Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin-Chun","family":"Tien","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"},{"name":"Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuh-Jyh","family":"Jong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"},{"name":"Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chen","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"},{"name":"Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Mou","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"},{"name":"Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Lung","family":"Shih","sequence":"additional","affiliation":[{"name":"Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7194-9147","authenticated-orcid":false,"given":"Cheng-Chang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan"},{"name":"Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Orthopaedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1016\/S0140-6736(08)60921-6","article-title":"Spinal muscular atrophy","volume":"371","author":"Lunn","year":"2008","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1007\/s00586-011-1758-x","article-title":"Cotrel-Dubousset instrumentation in neuromuscular scoliosis","volume":"20","author":"Piazzolla","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_3","first-page":"23","article-title":"Management of scoliosis in patients with Duchenne muscular dystrophy and spinal muscular atrophy: A literature review","volume":"9","author":"Garg","year":"2016","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1097\/BPO.0000000000000497","article-title":"What\u2019s new in the management of neuromuscular scoliosis","volume":"36","author":"Brooks","year":"2016","journal-title":"J. Pediatr. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1007\/s00586-016-4828-2","article-title":"The effect of scoliosis surgery on pulmonary function in spinal muscular atrophy type II patients","volume":"26","author":"Chou","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1007\/s00586-004-0760-y","article-title":"Blood loss in pediatric spine surgery","volume":"13","author":"Shapiro","year":"2004","journal-title":"Eur. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/00130478-200210000-00007","article-title":"Bleeding and coagulation changes during spinal fusion surgery: A comparison of neuromuscular and idiopathic scoliosis patients","volume":"3","author":"Kannan","year":"2002","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E549","DOI":"10.1097\/BRS.0b013e31823d009b","article-title":"Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis?","volume":"37","author":"Dhawale","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E460","DOI":"10.1097\/BSD.0b013e3182a22a54","article-title":"Antifibrinolytic use and blood transfusions in pediatric scoliosis surgeries performed at US children's hospitals","volume":"28","author":"McLeod","year":"2015","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1046\/j.1460-9592.2003.01171.x","article-title":"Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: Is there an increased risk?","volume":"13","author":"Edler","year":"2003","journal-title":"Paediatr. Anaesth."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e6292","DOI":"10.1097\/MD.0000000000006292","article-title":"Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis: A STROBE-compliant retrospective observational analysis","volume":"96","author":"Jia","year":"2017","journal-title":"Medicine (Baltim.)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3171\/2018.2.PEDS17724","article-title":"Perioperative complications and risk factors in neuromuscular scoliosis surgery","volume":"22","author":"Toll","year":"2018","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1056\/NEJM199807233390407","article-title":"Hemostatic drugs","volume":"339","author":"Mannucci","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Yang, B., Li, H., Wang, D., He, X., Zhang, C., and Yang, P. (2013). Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0055436"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/00000539-200107000-00018","article-title":"A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery","volume":"93","author":"Neilipovitz","year":"2001","journal-title":"Anesth. Analg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s11832-013-0486-7","article-title":"The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: A single-surgeon experience","volume":"7","author":"Lykissas","year":"2013","journal-title":"J. Child. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.2106\/JBJS.L.00008","article-title":"The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: A prospective randomized trial","volume":"96","author":"Verma","year":"2014","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1097\/BRS.0b013e31814cf139","article-title":"Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis","volume":"32","author":"Shapiro","year":"2007","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/00000542-200504000-00006","article-title":"Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery","volume":"102","author":"Sethna","year":"2005","journal-title":"Anesthesiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1046\/j.1537-2995.1997.371098016448.x","article-title":"A standardized method for calculating blood loss","volume":"37","author":"Brecher","year":"1997","journal-title":"Transfusion"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1097\/00007632-200210010-00012","article-title":"Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery","volume":"27","author":"Meert","year":"2002","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.1097\/BRS.0b013e3181d8342c","article-title":"The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: A systematic review","volume":"35","author":"Schuster","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.1016\/j.injury.2020.04.040","article-title":"Limiting blood loss in orthopaedic trauma. Strategies and effect","volume":"51","author":"Leighton","year":"2020","journal-title":"Injury"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1002\/bjs.10330","article-title":"Combined effect of therapeutic strategies for bleeding injury on early survival, transfusion needs and correction of coagulopathy","volume":"104","author":"Balvers","year":"2017","journal-title":"Br. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1056\/NEJMra032401","article-title":"Acute renal failure and sepsis","volume":"351","author":"Schrier","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1186\/2110-5820-2-S1-S1","article-title":"Fluid management in critically ill patients: The role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance","volume":"2","author":"Cordemans","year":"2012","journal-title":"Ann. Intensive Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1056\/NEJMra1208627","article-title":"Resuscitation fluids","volume":"369","author":"Myburgh","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/ANA.0000000000000028","article-title":"Factors that correlate with the decision to delay extubation after multilevel prone spine surgery","volume":"26","author":"Anastasian","year":"2014","journal-title":"J. Neurosurg. Anesthesiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/BRS.0b013e31826c63cb","article-title":"Prediction of massive blood loss in scoliosis surgery from preoperative variables","volume":"38","author":"Yu","year":"2013","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/19\/9959\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:03:17Z","timestamp":1760166197000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/19\/9959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,22]]},"references-count":29,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["ijerph18199959"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18199959","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,22]]}}}