{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:08:48Z","timestamp":1790078928329,"version":"4.0.1"},"reference-count":26,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objective: Unilateral biportal endoscopic (UBE) lumbar decompression is an effective minimally invasive spine surgery, but postoperative spinal epidural hematoma (PSEH) remains a practical concern. This study evaluated the clinical necessity of routine application of a bioabsorbable cellulose-based hemostatic agent in UBE lumbar decompression. Methods: This retrospective comparative study included 115 patients who underwent UBE unilateral laminectomy and bilateral decompression for lumbar spinal stenosis. Patients were divided into a control group without routine hemostatic agent application (n = 66) and a hemostatic group with routine hemostatic agent application (n = 49). Clinical outcomes, operation time, postoperative drain output, hemoglobin change, and PSEH on postoperative day (POD) 2 MRI were compared. Results: Baseline characteristics were comparable between the groups. Total drain output was significantly lower in the hemostatic group than in the control group (61.50 [50.00\u201378.50] mL vs. 77.00 [59.85\u201396.75] mL, p = 0.002), particularly on POD 2 (19.00 [11.20\u201322.50] mL vs. 25.00 [18.25\u201340.00] mL, p &lt; 0.001). Operation time was also shorter in the hemostatic group (41.43 \u00b1 6.69 min vs. 45.91 \u00b1 6.32 min, p &lt; 0.001). However, hemoglobin change, clinical outcomes, and PSEH incidence did not significantly differ between the groups. Symptomatic PSEH requiring revision surgery occurred in one control patient and in no hemostatic patients. Conclusions: Routine hemostatic agent application was not associated with a significant reduction in PSEH after UBE lumbar decompression. Although lower POD 2 drain output and shorter operative time were observed in the hemostatic group, the clinical significance of these findings remains uncertain and warrants further prospective study.<\/jats:p>","DOI":"10.3390\/jcm15187279","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7279","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Routine Application of a Bioabsorbable Cellulose Hemostatic Agent (WoundClotTM) in Unilateral Biportal Endoscopic Lumbar Decompression: A Retrospective Comparative Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9517-6193","authenticated-orcid":false,"given":"JinWoo","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hu Hospital, Busan 47261, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1751-2163","authenticated-orcid":false,"given":"Sang-Woo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hu Hospital, Busan 47261, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9353-775X","authenticated-orcid":false,"given":"Donghyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6668-0905","authenticated-orcid":false,"given":"Young San","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41405, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2899-8015","authenticated-orcid":false,"given":"Dae-Chul","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41405, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2531-6015","authenticated-orcid":false,"given":"Sang-Kyu","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Good Moonhwa Hospital, Busan 48735, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7620-207X","authenticated-orcid":false,"given":"Man-Kyu","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hu Hospital, Busan 47261, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"812","DOI":"10.14245\/ns.2550648.324","article-title":"Real-Time Water Pressure Monitoring in Unilateral Biportal Endoscopic Spine Surgery","volume":"22","author":"Yu","year":"2025","journal-title":"Neurospine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e324","DOI":"10.1016\/j.wneu.2019.05.141","article-title":"Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery","volume":"129","author":"Kim","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.spinee.2024.01.003","article-title":"Topical hemostatic agents in spinal surgery","volume":"24","author":"Shen","year":"2024","journal-title":"Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1159\/000514934","article-title":"WoundClot\u00ae Hemostatic Gauze Reduces Bleeding Time after Arterial Venous Fistula Decannulation","volume":"50","author":"Schwartz","year":"2021","journal-title":"Blood Purif."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/01.ASW.0000790488.72494.57","article-title":"Advances in hemostatic wound dressings: Clinical implications and insight","volume":"35","author":"Agarwal","year":"2022","journal-title":"Adv. Skin Wound Care"},{"key":"ref_6","first-page":"2","article-title":"Hemostasis with WoundClot Hemostatic Gauze in Orthopedic Oncology Surgery","volume":"5","author":"Segal","year":"2019","journal-title":"J. Orthop. Oncol."},{"key":"ref_7","first-page":"1932","article-title":"Life Threatening Complication Arterial Bleeding During Atlas-Axis Fusion Surgery Stopped with Wound Clot","volume":"3","author":"Rustam","year":"2018","journal-title":"Clin. Surg."},{"key":"ref_8","first-page":"38","article-title":"Managing Life-threatening Traumatic Hemorrhage: A New Solution for a Changing World Paradigm","volume":"4","author":"Deltoff","year":"2018","journal-title":"J. Emergen Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E413","DOI":"10.1097\/BRS.0b013e3181d9bb77","article-title":"Postoperative spinal epidural hematoma: A systematic review","volume":"35","author":"Glotzbecker","year":"2010","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.spinee.2012.10.028","article-title":"Postoperative spinal epidural hematoma (SEH): Incidence, risk factors, onset, and management","volume":"13","author":"Amiri","year":"2013","journal-title":"Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/BRS.0b013e31815e39af","article-title":"Prospective study of postoperative lumbar epidural hematoma: Incidence and risk factors","volume":"33","author":"Sokolowski","year":"2008","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1007\/s00586-005-0965-8","article-title":"Surgical management of spontaneous spinal epidural hematoma","volume":"15","author":"Shin","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.spinee.2007.01.009","article-title":"Clinical management for spontaneous spinal epidural hematoma: Diagnosis and treatment","volume":"8","author":"Matsumura","year":"2008","journal-title":"Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e786","DOI":"10.1016\/j.wneu.2019.02.150","article-title":"Evaluation of postoperative spinal epidural hematoma after biportal endoscopic spine surgery for single-level lumbar spinal stenosis: Clinical and magnetic resonance imaging study","volume":"126","author":"Kim","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"87","DOI":"10.31616\/asj.2023.0208","article-title":"Effect of thrombin-containing local hemostatics on postoperative spinal epidural hematoma in biportal endoscopic spinal surgery","volume":"18","author":"Ko","year":"2024","journal-title":"Asian Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4801641","DOI":"10.1155\/2020\/4801641","article-title":"Effectiveness of gelatin-thrombin matrix sealants (Floseal\u00ae) on postoperative spinal epidural hematoma during single-level lumbar decompression using Biportal endoscopic spine surgery: Clinical and magnetic resonance image study","volume":"2020","author":"Kim","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1111\/os.70009","article-title":"Use of fluid gelatin in lumbar spinal stenosis undergoing unilateral biportal endoscopic: A prospective, randomized controlled trial","volume":"17","author":"Yan","year":"2025","journal-title":"Orthop. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.spinee.2020.11.004","article-title":"Does prophylactic use of topical gelatin-thrombin matrix sealant affect postoperative drainage volume and hematoma formation following microendoscopic spine surgery? A randomized controlled trial","volume":"21","author":"Takami","year":"2021","journal-title":"Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.jseint.2025.02.003","article-title":"The reliability of deep learning models in assessing the shoulder arthroscopic field\u2019s visual clarity in relation to bleeding","volume":"9","author":"Tran","year":"2025","journal-title":"JSES Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.jclinane.2011.03.004","article-title":"The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: A placebo-controlled clinical trial","volume":"23","author":"Alimian","year":"2011","journal-title":"J. Clin. Anesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s00405-018-05268-6","article-title":"Rating surgical field quality in endoscopic ear surgery: Proposal and validation of the \u201cModena Bleeding Score\u201d","volume":"276","author":"Pingani","year":"2019","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"58","DOI":"10.21037\/jss.2017.02.04","article-title":"Spontaneous spinal epidural hematoma: Literature review","volume":"3","author":"Figueroa","year":"2017","journal-title":"J. Spine Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16043","DOI":"10.1038\/scsandc.2016.43","article-title":"Spontaneous spinal epidural hematoma management: A case series and literature review","volume":"3","author":"Raasck","year":"2017","journal-title":"Spinal Cord Ser. Cases"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"438","DOI":"10.21037\/jss.2020.03.08","article-title":"Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis","volume":"6","author":"Pao","year":"2020","journal-title":"J. Spine Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.21182\/jmisst.2024.01543","article-title":"Hemostasis in endoscopic spine surgery","volume":"10","author":"Feng","year":"2025","journal-title":"J. Minim. Invasive Spine Surg. Tech."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.spinee.2021.07.009","article-title":"MRI appearance of adjunct surgical material used in spine surgery","volume":"22","author":"Altorfer","year":"2022","journal-title":"Spine J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7279\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:29:44Z","timestamp":1790076584000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,19]]},"references-count":26,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187279"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187279","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,19]]}}}