AIM: To evaluate the efficacy and safety of topical tranexamic acid (tTXA) in thoracolumbar fusion surgery.

MATERIAL and METHODS: A systematic review was conducted per PRISMA guidelines. Studies from January 1970 to August 2024 were retrieved from PubMed, Cochrane, EMBASE, Medline, and Google Scholar. Randomized controlled trials, non-RCTs, and cohort studies comparing tTXA with placebo or standard care in thoracolumbar surgery were included.

RESULTS: Eleven studies with 986 patients met the criteria. tTXA significantly reduced intraoperative blood loss (MD: -25.85 mL, p = 0.002), postoperative drain output (MD: -84.82 mL, p < 0.00001), transfusion rates (OR: 0.33, p = 0.0004), and hospital stay (MD: -0.67 days, p < 0.00001). It also increased postoperative hemoglobin (MD: 0.39 g/dL, p < 0.00001) but slightly prolonged operative time (MD: 3.73 minutes, p < 0.00001). No significant difference was found in complication rates (p = 0.36).

CONCLUSION: tTXA is effective in reducing blood loss and transfusion needs in thoracolumbar surgery, with minimal risk. Slightly increased operative time is clinically acceptable.