Tranexamic Acid in Adult Spinal Deformity Surgery

Inclusion Criteria: * Age 18-80 * Scheduled to undergo posterior long segment ( ≥ 5 levels) posterior spinal fusion for adult scoliosis or degenerative joint diseae * \+ fusion to pelvis Exclusion Criteria: * Surgical factors: * Anterior Approach * Presence or history of dural tear without repair as evidenced by pseudomeningocele on MRI imaging or by intraoperative exploration * Patients donating autologous blood preoperatively Patient factors: * Diagnosis of renal (Cr\>1.5 or CrCl \<30ml/min) or hepatic insufficiency (AST, ALT 2x upper limit of normal) * Diagnosis of seizure disorder or prior seizure * History of thromboembolic events (CVA, TIA, DVT, PE) if within 1 year of surgery * Hypercoagulability (e.g. antiphospholipid syndrome) * History of coronary artery disease (stent, MI, +stress test) within 1 year of surgery * Atrial fibrillation * Concurrent anticoagulation therapy that cannot be discontinued within 3 days before surgery (Coumadin, plavix, LVX) * Concurrent anticoagulation with ASA 325 that cannot be discontinued 10 days before surgery * Bleeding disorder or abnormal preoperative coagulation profile (as identified by a preoperative platelet count of \<100,000/mm3, an international normalized ratio of \>1.4, or a prolonged partial thromboplastin time \>1.4 times normal) * Preexisting anemia \<10 g/dL * Color blindness or disturbance of color vision * Leukemia or active cancer * Religious restrictions on blood transfusion * Pregnancy or women who are lactating/breastfeeding