Objective:

The aim of the study was to evaluate the efficacy and safety of Gelatin Thrombin Matrix Sealants (GTMS) in minimizing blood loss during the perioperative period and preventing complications in patients undergoing lumbar decompression or fusion surgery. 

Background:

Significant intraoperative bleeding during lumbar spine surgery typically complicates the procedure, increasing morbidity, transfusion rates, and length of stay. Conventional hemostatic techniques are frequently ineffective against diffuse venous bleeds and cancellous bone ooze. GTMS (e.g Floseal®,Surgiflo®) provide rapid hemostasis, but their high cost and inconsistent evidence have limited their standardized adoption. 

Design/Methods:

We performed a systematic review and meta-analysis of randomized controlled trials and cohort studies assessing postoperative drain output, hemostasis within 3 minutes, and epidural hematoma as primary outcomes, while intraoperative blood loss, operative time, transfusion rate, and hospital stay were secondary outcomes. Following PRISMA 2020 and PROSPERO (CRD420251145811), we searched PubMed, Cochrane Central, and ClinicalTrials.gov through October 2025 and used random-effects models with SMD, 95% CI, and I² statistics.

Results:

Eight studies (n =1,207;645 GTMS, 562 control) were included. GTMS significantly reduced postoperative drain output (MD –15.18 mL; 95% CI –20.38 to –9.98; p < 0.0001; I² =0%) and increased hemostasis within 3 minutes (RR 1.30; 95% CI 1.10 to 1.53; p =0.002). Epidural hematoma incidence was lower with GTMS (RR 0.47; 95% CI 0.27 to 0.84; p =0.01). GTMS shortened hospital stay (MD –0.56 days; 95% CI –1.01 to –0.10; p =0.016). Effects on intraoperative blood loss, post-operative transfusion rate and surgical time were not statistically significant. Reported adverse effects were mild and of short duration. 

Conclusions:

GTMS use during lumbar surgery is linked to lower drain output, better intraoperative hemostasis, and fewer epidural hematomas. While these findings support broader use, cost considerations and the need for a standardized procedural approach remain key factors for its adoption in routine clinical practice.