Design: Prospective randomised controlled trial, blinded outcome assessment
Population: 58 adults undergoing single-level full-endoscopic lumbar discectomy
Primary outcome: Intraoperative visualisation (visual analogue and automated video scores)
Effect: No significant difference; treatment effect -0.31 (95% CI -1.0 to 0.41)

Prophylactic tranexamic acid is used to reduce bleeding and improve the operative field, but whether it adds anything in single-level full-endoscopic lumbar discectomy — where continuous irrigation already gives a clear view — was untested. This randomised trial of 58 patients compared intravenous tranexamic acid with standard care.

Visualisation was good in both arms and no better with the drug. Surgeon-rated visual analogue scores had a median of 8 in each group, the estimated treatment effect was -0.31 (95% CI -1.0 to 0.41), and automated video measures of blood in the field were similar. Operative duration did not differ significantly, and no thromboembolic or drug-related adverse events occurred.

The practical message is narrow but useful: do not add tranexamic acid specifically to improve the view in single-level endoscopic lumbar discectomy. The drug was safe, and this says nothing about its established role in higher-blood-loss procedures.

Randomised trial, 58 patients, single-level full-endoscopic lumbar discectomy.
Visualisation was equally good with and without tranexamic acid (median surgeon score 8 in both).
Estimated treatment effect on the visual score was -0.31 (95% CI -1.0 to 0.41), not significant.
Operative time did not differ; no thromboembolic or drug-related adverse events occurred.
This addresses visualisation only, not blood loss in higher-risk procedures.

Why it matters

It checks a plausible add-on against a real endpoint and finds no benefit, sparing an unnecessary drug in a low-bleeding operation.

The statistics, in plain English

A treatment-effect confidence interval that straddles zero means no detectable difference; a negative result in a procedure that already has clear views does not argue against tranexamic acid where blood loss is genuinely a problem.