Global Spine Journal

Blood Management and Conservation During Adult Spine Deformity Surgery

Jul 9, 2025

5 min

Objective

To summarize and critically assess the evidence for blood conservation strategies before, during, and after adult spine deformity surgery.

Methods

A systematic literature search was conducted, and studies were selected for narrative analysis of perioperative blood conservation techniques. These included preoperative preparation, intraoperative strategies, and postoperative management aimed at reducing blood loss and transfusion requirements.

Results

Evidence was analyzed for multiple strategies, such as:

Preoperative iron supplementation and anemia management
Autologous blood donation and screening for bleeding diatheses
Optimal surgical team composition and operative techniques
Hypotensive anesthesia and patient positioning
Use of antifibrinolytics including tranexamic acid (intravenous and topical)
Transfusion thresholds, cell salvage, and topical hemostatic agents
Postoperative drainage and anticoagulant management

The management of hemorrhage in adult deformity surgery is complex. While some techniques (e.g., tranexamic acid and hypotensive anesthesia) are supported by stronger evidence, other common practices lack robust data. Overall, strategies that minimize surgical time, optimize team efficiency, and proactively reduce bleeding tend to have the greatest impact on reducing blood loss and transfusion needs.

Conclusion

Effective blood management in adult spine deformity surgery requires a multifaceted approach across all phases of care. Surgeons should consider evidence-based strategies such as preoperative anemia correction, intraoperative blood conservation techniques, and adequate use of antifibrinolytics to minimize hemorrhage and transfusion risk.

Clinical Relevance

This review offers practical guidance for clinicians to improve perioperative blood conservation and patient safety during complex adult spinal deformity procedures.