Decortication during instrumentation and fusion of the vertebral column accounts for the majority of blood loss during spinal surgery. The factors predicting increased blood loss and the need for transfusion include surgical technique, type of surgery (fusion versus laminectomy), low preoperative hemoglobin, tumor surgery, increased number of levels fused, and underlying pulmonary disease (9). Factors likely to decrease blood loss include acute normovolemic hemodilution, use of the Jackson table, hypotensive techniques, and the use of cell saver. Monitoring for development of intraoperative coagulopathy includes testing PT/INR and PTT.