Routine Application of a Bioabsorbable Cellulose Hemostatic Agent (WoundClotTM) in Unilateral Biportal Endoscopic Lumbar Decompression: A Retrospective Comparative Study.

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 [50.00-78.50] mL vs. 77.00 [59.85-96.75] mL, p = 0.002), particularly on POD 2 (19.00 [11.20-22.50] mL vs. 25.00 [18.25-40.00] mL, p < 0.001). Operation time was also shorter in the hemostatic group (41.43 ± 6.69 min vs. 45.91 ± 6.32 min, p < 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.