J Minim Invasive Spine Surg Tech.  2025 Jan;10(Suppl 1):S20-S26. 10.21182/jmisst.2024.01543.

Hemostasis in Endoscopic Spine Surgery

• Feng TT
• Kwon WK
• Ling JM
• Tan TCH

• KMID: 2566276
• DOI: http://doi.org/10.21182/jmisst.2024.01543

Abstract

Bleeding is a commonly encountered problem in spine surgery. The increasing popularity of endoscopic spine surgery poses new challenges to spine surgeons, especially those who are embarking on the learning curve. Hemostasis in endoscopic spine surgery can be difficult due to the narrow working channel and bleeding obscuring the endoscopic view, which hinders hemostasis and effective continuation of the operation. To minimize the risk of bleeding and improve hemostasis, a multimodal approach should be employed, including appropriate strategies for perioperative prevention, intraoperative surgical techniques, and postoperative correction/care. In this technical review article, we discuss several hemostatic techniques that are commonly used in endoscopic spine surgery. We also describe a new bone wax application technique in endoscopic spine surgery—called the “bone wax on pattie” technique—to avoid bone wax sticking onto the working channel/endoscope lens, while enabling easier application of bone wax onto the bleeding bone surface. We share some of our experiences with hemostasis in endoscopic spine surgery, and we hope to gather feedback from fellow spine surgeons around the world, so that we can contribute to further developments in the field together.

Keyword

Endoscopy; Spine; Surgery; Hemostasis; Techniques; Bone wax