Design: Randomised controlled trial with blinded outcome assessment
Population: 58 adults having single-level full-endoscopic lumbar discectomy
Primary outcome: Intraoperative visualisation (visual analogue scale)
Effect: Median VAS 8 vs 8; difference −0.31 (95% CI −1.0 to 0.41)

A randomised trial in Neurosurgical Focus, published on 1 October, gave 58 adults having single-level full-endoscopic lumbar discectomy either intravenous tranexamic acid (10 mg/kg, maximum 1 g) before induction or no tranexamic acid. Surgeons and two independent evaluators, all blinded, rated the endoscopic view, and automated video analysis measured blood in the field.

The view was good in both groups. Median surgeon visual analogue score was 8 in each arm, and the regression estimate of the tranexamic acid effect was −0.31 points (95% CI −1.0 to 0.41). Blood pixel ratio and derived visualisation scores did not differ, nor did operating time. There were no thromboembolic or drug-related adverse events.

Tranexamic acid has a clear role in procedures with substantial blood loss. In single-level endoscopic discectomy, where irrigation and pump pressure already keep the field clear, this trial gives no reason to add it routinely for visualisation. It was small, so a modest benefit cannot be excluded.

Do not add tranexamic acid routinely to single-level endoscopic discectomy to improve the view.
Keep using it where blood loss is the concern, such as multilevel open spine surgery.
Manage the endoscopic field with irrigation, pump pressure and blood pressure control first.
Record a visualisation rating if auditing your own endoscopic practice.

Why it matters

It removes a reason for a drug many units were adding by habit to short endoscopic cases.

The statistics, in plain English

The confidence interval for the effect (−1.0 to 0.41 on a 10-point scale) includes zero and excludes any large benefit. With 58 patients, a small benefit is still possible.