Dual-Mode Rapid Hemostatic Materials Composed of Gelatin and Carboxymethyl Cellulose for Non-Compressible Bleeding in Spinal Surgery

Abstract Spinal surgery, particularly spinal decompression and fusion surgery, commonly encounters intraoperative bleeding. Deep bleeding in the narrow operative area (e.g., bone marrow cavity and venous plexus) is a significant challenge for achieving accurate hemostasis with traditional strategies, posing a life-threatening risk. Herein, a novel dual-form hemostatic material (CMC-Gelatin, CG) composed of carboxymethyl cellulose (CMC) and gelatin is developed for non-compressible hemostasis in spinal surgery. For minor bleeding, CG in powder form reduces blood loss by 69.06% within a mouse bleeding model, demonstrating hemostatic efficacy comparable to that of the commercial Surgicel® powder, while exhibiting superior cytocompatibility. Notably, CG powder rapidly forms an injectable gel upon mixing with saline, making it suitable for severe bleeding in a confined space during spinal surgery. Specifically, in a pig paraspinal microvenous hemorrhage model, CG gel exhibits excellent hemostatic performance, reducing blood loss by 78.44% compared with the untreated group. Importantly, CG demonstrated a comparable hemostasis time and reduced blood loss in vivo compared to the commercial Surgiflo®. The designed CG materials exhibit outstanding hemostatic properties in deep, narrow areas, making them a promising hemostatic material in spinal surgery.