{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T22:10:56Z","timestamp":1785190256831,"version":"3.55.0"},"reference-count":119,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Massive intraoperative blood loss (IBL) is a serious complication in complex spine surgeries such as deformity correction, multilevel fusion, tumor resection, and revision procedures. While no strict definition exists, blood loss exceeding 1500 mL or 20% of estimated blood volume is generally considered clinically significant. Excessive bleeding increases the risk of hemodynamic instability, transfusion-related complications, postoperative infection, and prolonged hospitalization. Methods: This narrative review summarizes the current understanding of the incidence, risk factors, anatomical vulnerabilities, and evidence-based strategies for managing IBL in spine surgery through comprehensive literature analysis of recent studies and clinical guidelines. Results: Key risk factors include patient characteristics (anemia, obesity, advanced age, medication use), surgical variables (multilevel instrumentation, revision status, operative time), and pathological conditions (hypervascular tumors, severe deformity). Perioperative medication management is critical, requiring discontinuation of NSAIDs (5\u20137 days), antiplatelet agents (5\u20137 days), and NOACs (48\u201372 h) preoperatively to minimize bleeding risk. The thoracolumbar junction and hypervascular spinal lesions are especially prone to bleeding due to dense vascular anatomy. Evidence-based management strategies include comprehensive preoperative optimization, intraoperative hemostatic techniques, antifibrinolytic agents, topical hemostatic products, cell salvage technology, and structured transfusion protocols. Conclusions: Effective management of massive IBL requires a multimodal approach combining preoperative risk assessment and medication optimization, intraoperative hemostatic strategies including tranexamic acid administration, advanced monitoring techniques, and coordinated transfusion protocols. Particular attention to perioperative management of anticoagulant and antiplatelet medications is essential for bleeding risk mitigation. Understanding patient-specific risk factors, surgical complexity, and anatomical considerations enables surgeons to implement targeted prevention and management strategies, ultimately improving patient outcomes and reducing complications in high-risk spine surgery procedures.<\/jats:p>","DOI":"10.3390\/life15101615","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T16:33:22Z","timestamp":1760632402000},"page":"1615","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Safety in Spine Surgery: Risk Factors for Intraoperative Blood Loss and Management Strategies"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9627-7781","authenticated-orcid":false,"given":"Magdalena","family":"Rybaczek","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Kowalski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Regional Specialized Hospital, ul. Dekerta 1, 66-400 Gorzow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4132-9278","authenticated-orcid":false,"given":"Zenon","family":"Mariak","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Grabala","sequence":"additional","affiliation":[{"name":"2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, M. Sk\u0142odowskiej-Curie 24A, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Suszczy\u0144ska","sequence":"additional","affiliation":[{"name":"2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, M. Sk\u0142odowskiej-Curie 24A, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9757-8276","authenticated-orcid":false,"given":"Tomasz","family":"\u0141yso\u0144","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7059-2935","authenticated-orcid":false,"given":"Pawe\u0142","family":"Grabala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Polish-Mother\u2019s Memorial Hospital Research Institute, Rzgowska 281\/289, 93-338 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1007\/s00586-022-07249-0","article-title":"Combined anterior-posterior versus all-posterior approaches for adult spinal deformity correction: A matched control study","volume":"31","author":"Haddad","year":"2022","journal-title":"Eur. 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