Impact of tranexamic acid on visualization in full endoscopic spine surgery: a randomized controlled trial

The aim of this study was to evaluate whether prophylactic administration of intravenous tranexamic acid (TXA) improves intraoperative visualization during full-endoscopic lumbar spine surgery for single-level degenerative disc herniation.

A prospective, randomized controlled trial was conducted including adult patients undergoing single-level, full-endoscopic lumbar discectomy. Participants were randomly allocated in a 1-to-1 ratio to receive either intravenous TXA (10 mg/kg, maximum 1 g) prior to anesthesia induction or standard care without TXA. Intraoperative visualization was assessed using a visual analog scale (VAS) and a 4-grade visualization scale by the operating surgeon and two independent evaluators, all of whom were blinded to group allocation. Secondary outcomes included operative parameters such as surgery duration, irrigation fluid volume, pump pressure, and the need to reduce blood pressure. An automated video analysis was performed to evaluate blood in the endoscopic field. Outcomes included a blood pixel ratio (BPR) and a derived visualization score (DVZ).