Abstract: Objective To compare the effect of tranexamic acid (TXA) alone versus TXA+Surgiflo for perioperative hemostasis in patients with degenerative lumbar spondylolisthesis. Methods Clinical data about 65 patients with degenerative lumbar (L4) spondylolisthesis admitted to Joint Service Support Force 981 Hospital from March 2013 to March 2017 were retrospectively analyzed.There were 32 patients in TXA group,including 13 males and 19 females,with average age of (59.96±7.52) years.Another 33 patients were in TXAS (TXA+Surgiflo) group,including 15 males and 18 females,with average age of (61.00±6.33) years.Preoperative systolic pressure (SP) and coagulation indicators,perioperative hemoglobin (HGB),surgical duration (SD),blood loss (BL),success rate of hemostasis (SRH) at 3mins and 5 mins,bleeding volume during hemostasis (BVH) in 3 mins,number of autologous blood transfusion (ABT),postoperative drainage volume (PDV) as well as duration of tube drainage (DTD) were recorded. Results There was no statistically significant difference in general characteristics,including age,gender and preoperative HGB,SP or coagulation indicators between the two groups.SRH at 3mins and 5 mins (3 min:63.64% vs 34.48%;5 min:93.94% vs65.63%;P<0.05,respectively),BVH at 3 mins (43.33±23.05ml vs60.72±25.73ml),blood loss (190.61±62.42ml vs219.90±53.61ml),PDV at 1 d,2 d (1 d:276.48±52.53ml vs301.03±45.16ml;2 d:100.97±20.02ml vs113.56±22.66ml)in the TXAS group were superior to the TXA group (all P<0.05).There were 15 cases (46.88%) with autotransfusion in the TXA group,which was greater than that in the TXAS group (5 cases,15.15%).No statistically significant difference was found in PDV of 3 d,HGB of postoperative 1 d,4 d,SD or DTD between the two groups. Conclusion TXA+Surgiflo show more advantages in perioperative hemorrhage control,less requirement of postoperative blood transfusion and faster hemostasis in the surgery than TXA alone.