The Role of Intravenous Tranexamic Acid for Posterior Spinal Fusion in Pediatric Non-Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

Background: Tranexamic acid (TXA) is increasingly used to reduce perioperative blood loss during scoliosis surgery; however, its effectiveness in pediatric patients with non-idiopathic scoliosis remains underexplored. Unlike adolescent idiopathic scoliosis, non-idiopathic scoliosis is frequently associated with neuromuscular, syndromic, or other underlying disorders that increase surgical complexity and may limit the generalizability of evidence from idiopathic populations. This systematic review and meta-analysis evaluated the impact of TXA on surgical outcomes in pediatric patients undergoing posterior spinal fusion for non-idiopathic scoliosis. Methods: This analysis encompassed five studies (comprising one randomized controlled trial and four observational studies) involving a total of 230 patients (TXA group: 98; control group: 132). The primary outcomes were estimated blood loss and the volume of packed red blood cells (PRBCs) transfused. Secondary outcomes included total transfusion amount, operation duration, complications, cell salvage application, preoperative hematocrit levels and blood loss percentage. A random-effects model was used. Mean difference (MD) was used for continuous outcomes, and odds ratio (OR) for dichotomous variables, both with 95% confidence intervals (CIs). Results: The use of TXA during posterior fusion surgery showed to be of benefit and was associated with significantly less estimated blood loss (p < 0.0001) and cell salvage volume transfusion (p < 0.0001). The remaining secondary outcomes did not show significant differences when compared with the control. Conclusion: Current evidence suggests that TXA is an effective blood conservation strategy in pediatric patients undergoing posterior spinal fusion for non-idiopathic scoliosis. However, the available evidence remains limited, particularly regarding perioperative complications, and further high-quality prospective studies are required to strengthen the evidence base. Clinical relevance: Exploring the use of TXA in scoliosis surgery has the potential to influence the standard of care, especially if associated with significantly more desirable post-operative and long-term outcomes.