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Study Design: This is a retrospective study of sequential cohorts., Objective: To assess the efficacy of tranexamic acid in decreasing operative blood loss and the need for intraoperative transfusion in metastatic spine surgery., Summary of Background Data: Significant published data have established the efficacy of antifibrinolytic drugs in limiting surgical bleeding during heart surgery and total joint replacement. One study in scoliosis suggested benefit in spine surgery as well., Methods: During a 6-month trial period, 14 patients with spine cancer undergoing palliative intralesional tumor excision and concomitant instrumentation to stabilize the spine in the hands of a single surgeon were administered tranexamic acid intraoperatively in the attempt to minimize operative blood loss. They were then compared to the immediately preceding 14 patients., Results: Estimated operative blood loss was 1385 mL in the study group treated with tranexamic acid and 1815 mL in controls not receiving the drug, and was not found to be significantly decreased in this study., Conclusions: Control of operative bleeding in metastatic spine surgery can be problematical. Optimum protocol might include routine preoperative angiographic tumor embolization to decrease lesion vascularity in all cases, but angiography is not without risk. Noninvasive prophylaxis of tumor bleeding would have obvious desirable advantages but was, unfortunately, not achieved in this study.

The clinical problem of primary and secondary vertebral tumours is encountered with increasing frequency throughout North America as oncologic management protocols evolve and the population continues to age. These lesions can present problems of pain, instability and paralysis. Optimal surgical palliation is often of benefit when more conservative methods have been unsuccessful. Vertebral tumours can be approached either anteriorly or posteriorly. These alternatives have led to the evolution in the clinical community of two "camps" championing their respective approaches. The authors have reviewed the accumulated literature up to December 1988 and have found that anterior approaches offer improved clinical outcome without substantially increased morbidity.