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.