Aim:In thoracolumbar spine surgery, managing intraoperative blood loss remains a challenge. Topical tranexamic acid (tTXA) has emerged as a cost-effective alternative, providing localized antifibrinolytic effects without the systemic risks of intravenous administration. This meta-analysis evaluates the efficacy and safety of tTXA in thoracolumbar fusion surgery.Material and Methods:A systematic review was conducted per PRISMA guidelines. Studies from January 1970 to August 2024 were retrieved from PubMed, Cochrane, EMBASE, Medline, and Google Scholar. Randomized controlled trials, non-RCTs, and cohort studies comparing tTXA with placebo or standard care in thoracolumbar surgery were included.Results:Eleven studies with 986 patients met the criteria. tTXA significantly reduced intraoperative blood loss (MD: -25.85 mL, p = 0.002), postoperative drain output (MD: -84.82 mL, p < 0.00001), transfusion rates (OR: 0.33, p = 0.0004), and hospital stay (MD: -0.67 days, p < 0.00001). It also increased postoperative hemoglobin (MD: 0.39 g/dL, p < 0.00001) but slightly prolonged operative time (MD: 3.73 minutes, p < 0.00001). No significant difference was found in complication rates (p = 0.36). Conclusion:tTXA is effective in reducing blood loss and transfusion needs in thoracolumbar surgery, with minimal risk. Slightly increased operative time is clinically acceptable.