Ninety-three patients with acute thoracolumbar burst fractures scheduled for an open decompression, fracture reduction and internal fixation procedure were randomized to receive topical tranexamic acid (n=46) or normal saline (n=47) after wound incision for the reduction of blood loss. Outcomes of interest included blood loss (intra-operative, post-operative, total, hidden), operative time, hemoglobin levels, transfusion rate, ambulation time, drainage tube removal time, and length of stay. Blood loss was assessed up to 72 hours post-operation. Results revealed that topical tranexamic acid significantly reduced blood loss (intra-operative; post-operative; total), operative time, hemoglobin levels on post-operative day 1, transfusion rate, ambulation time, drainage removal time, and length of stay compared to control.