{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:50:48Z","timestamp":1791334248520,"version":"4.3.1"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>All 58 randomized participants completed the study. Visualization quality was high in both cohorts. The median surgeon-reported VAS was 8 (interquartile range [IQR] 6\u20139) in both the TXA and control groups (p = 0.4). Surgeon visual classifications were similar (p = 0.8), with \"excellent\" or \"good\" ratings reported in 72% of the TXA group and 79% of the control group. Independent evaluator VAS scores yielded equivalent medians of 8 (p = 0.6 for evaluator 1, p = 0.8 for evaluator 2). A univariate linear regression evaluating the treatment effect of TXA on the mean VAS score showed an estimated difference of \u22120.31 (95% CI \u22121.0 to 0.41; p = 0.57). The median DVZ (9.30 vs 9.22; p = 0.3) and the median BPR (3.55% vs 4.57%; p = 0.3) were similar in both groups. The median operative duration was 50 (IQR 40\u201365) minutes for TXA and 60 (IQR 45\u201370) minutes for controls (p = 0.2). No thromboembolic complications or TXA-related adverse events were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Endoscopic lumbar discectomy offers good or excellent intraoperative visualization in most cases. This study did not demonstrate a significant improvement in intraoperative visualization with the prophylactic administration of intravenous TXA. While TXA appeared safe, its routine use specifically to enhance visual clarity in single-level endoscopic lumbar discectomy was not currently supported by these data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.7.focus26349","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:05:39Z","timestamp":1790121939000},"page":"E8","source":"Crossref","is-referenced-by-count":0,"title":["Impact of tranexamic acid on visualization in full endoscopic spine surgery: a randomized controlled trial"],"prefix":"10.3171","volume":"61","author":[{"given":"Joao","family":"Meira","sequence":"first","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto; and"},{"name":"Neurosurgery Department, ULS S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa","family":"Cunha","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto; and"},{"name":"Neurosurgery Department, ULS S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osvaldo","family":"Sousa","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto; and"},{"name":"Neurosurgery Department, ULS S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Pereira","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto; and"},{"name":"Neurosurgery Department, ULS S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Santos","family":"Silva","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto; and"},{"name":"Neurosurgery Department, ULS S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"J Shoulder Elbow Surg","first-page":"2389","article-title":"Tranexamic acid use in arthroscopic rotator cuff repair is an effective and safe adjunct to improve visualization: a systematic review and meta-analysis","volume":"32","author":"Han C","year":"2023","unstructured":"Han C, Liu M, Lian X,  Tranexamic acid use in arthroscopic rotator cuff repair is an effective and safe adjunct to improve visualization: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2023;32(11):2389\u20132399. doi:10.1016\/j.jse.2023.06.013"},{"issue":"1","key":"b2","series-title":"J Spine Surg","first-page":"68","article-title":"Does the use of tranexamic acid intraoperatively reduce postoperative blood loss and complications following biportal endoscopic lumbosacral decompression?","volume":"10","author":"Upfill-Brown A","year":"2024","unstructured":"Upfill-Brown A, Olson T, Adejuyigbe B,  Does the use of tranexamic acid intraoperatively reduce postoperative blood loss and complications following biportal endoscopic lumbosacral decompression? J Spine Surg. 2024;10(1):68\u201379. doi:10.21037\/jss-23-129"},{"issue":"4","key":"b3","series-title":"Clin Shoulder Elb","first-page":"455","article-title":"Improving visualization in shoulder arthroscopy","volume":"26","author":"McDermott ER","year":"2023","unstructured":"McDermott ER, Tennent DJ, Song DJ. Improving visualization in shoulder arthroscopy. Clin Shoulder Elb. 2023;26(4):455\u2013461. doi:10.5397\/cise.2022.01291"},{"key":"b4","series-title":"World Neurosurg","first-page":"e18","article-title":"Safety and efficacy of high-dose tranexamic acid in spine surgery: a retrospective single-institution series","volume":"177","author":"Brown NJ","year":"2023","unstructured":"Brown NJ, Pennington Z, Himstead AS,  Safety and efficacy of high-dose tranexamic acid in spine surgery: a retrospective single-institution series. World Neurosurg. 2023;177:e18\u2013e25. doi:10.1016\/j.wneu.2023.04.058"},{"issue":"2","key":"b5","series-title":"Arthroscopy","first-page":"519","article-title":"Editorial commentary: the current evidence in support of tranexamic acid in arthroscopic surgery is poor","volume":"38","author":"Hohmann E","year":"2022","unstructured":"Hohmann E. Editorial commentary: the current evidence in support of tranexamic acid in arthroscopic surgery is poor. Arthroscopy. 2022;38(2):519\u2013521. doi:10.1016\/j.arthro.2021.11.014"},{"issue":"3","key":"b6","series-title":"Br J Anaesth","first-page":"380","article-title":"Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial","volume":"118","author":"Colomina MJ","year":"2017","unstructured":"Colomina MJ, Koo M, Basora M, Pizones J, Mora L, Bag\u00f3 J. Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial. Br J Anaesth. 2017;118(3):380\u2013390. doi:10.1093\/bja\/aew434"},{"issue":"4","key":"b7","series-title":"Arthroscopy","first-page":"1334","article-title":"Editorial commentary: the benefits of tranexamic acid may outweigh risks in arthroscopy and sports medicine","volume":"37","author":"Alaia MJ","year":"2021","unstructured":"Alaia MJ, Gipsman AM. Editorial commentary: the benefits of tranexamic acid may outweigh risks in arthroscopy and sports medicine. Arthroscopy. 2021;37(4):1334\u20131336. doi:10.1016\/j.arthro.2021.01.027"},{"issue":"1","key":"b8","series-title":"J Orthop Allied Sci","first-page":"8","article-title":"Rating visualization in shoulder arthroscopy: a comparison of the visual analog scale versus a novel shoulder arthroscopy grading scale","volume":"7","author":"Lands VW","year":"2019","unstructured":"Lands VW, Avery DM, Malige A, Stoltzfus J, Gibson BW, Carolan GF. Rating visualization in shoulder arthroscopy: a comparison of the visual analog scale versus a novel shoulder arthroscopy grading scale. J Orthop Allied Sci. 2019;7(1):8\u201311. doi:10.4103\/joas.joas_8_18"},{"issue":"4","key":"b9","series-title":"J Spine Surg","first-page":"1035","article-title":"BLEED-LESS: a scoping review on blood loss elimination in endoscopic decompression\u2014lessons and literature on endoscopic spine surgery","volume":"11","author":"Ma A","year":"2025","unstructured":"Ma A, Reidy J, Mobbs RJ. BLEED-LESS: a scoping review on blood loss elimination in endoscopic decompression\u2014lessons and literature on endoscopic spine surgery. J Spine Surg. 2025;11(4):1035\u20131043. doi:10.21037\/jss-25-11"},{"key":"b10","series-title":"Ther Clin Risk Manag","first-page":"325","article-title":"Effect of tranexamic acid on hidden blood loss in percutaneous endoscopic transforaminal lumbar interbody fusion: a retrospective study","volume":"20","author":"Li Y","year":"2024","unstructured":"Li Y, Ge M, Tian J,  Effect of tranexamic acid on hidden blood loss in percutaneous endoscopic transforaminal lumbar interbody fusion: a retrospective study. Ther Clin Risk Manag. 2024;20:325\u2013334. doi:10.2147\/TCRM.S462784"},{"issue":"9","key":"b11","series-title":"Eur Spine J","first-page":"1950","article-title":"Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials","volume":"22","author":"Li ZJ","year":"2013","unstructured":"Li ZJ, Fu X, Xing D, Zhang HF, Zang JC, Ma XL. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J. 2013;22(9):1950\u20131957. doi:10.1007\/s00586-013-2774-9"},{"issue":"3","key":"b12","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"280","article-title":"The efficacy and safety of topical saline irrigation with tranexamic acid on perioperative blood loss in patients treated with percutaneous endoscopic interlaminar diskectomy: a retrospective study","volume":"85","author":"Zhang Y","year":"2024","unstructured":"Zhang Y, Zhao W, Hu M,  The efficacy and safety of topical saline irrigation with tranexamic acid on perioperative blood loss in patients treated with percutaneous endoscopic interlaminar diskectomy: a retrospective study. J Neurol Surg A Cent Eur Neurosurg. 2024;85(3):280\u2013287. doi:10.1055\/s-0043-1769127"},{"issue":"6","key":"b13","series-title":"Acta Orthop Traumatol Turc","first-page":"318","article-title":"Efficacy of tranexamic acid in improving visual clarity and operative time of arthroscopic rotator cuff repair: a systematic review and meta-analysis","volume":"58","author":"Qian Y","year":"2024","unstructured":"Qian Y, Jiang A, Yan J, Zhang S, Zhu S. Efficacy of tranexamic acid in improving visual clarity and operative time of arthroscopic rotator cuff repair: a systematic review and meta-analysis. Acta Orthop Traumatol Turc. 2024;58(6):318\u2013325. doi:10.5152\/j.aott.2024.24008"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/4\/article-pE8.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/4\/article-pE8.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/4\/article-pE8.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:01:02Z","timestamp":1791331262000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/4\/article-pE8.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":13,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2026.7.focus26349","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}