BACKGROUND: To avoid complications of homologous transfusion, many methods are used in patients who undergo an operation, but the autologous transfusion is most popular. This retrospective study was done to evaluate the applicability of an autologous transfusion in an orthopedic spinal surgery. METHODS: The cases of 239 autologous transfusion and 85 homologous transfusions in patients who had spinal surgery due to spinal stenosis were reviewed, and the differences in homologous transfusion, postoperative drainage and complications in both groups were compared. Both groups were analysed and compared by the T-test and Mann-Whitmann rank sum test. RESULTS: In the homologous transfusion group, 4.6 +/- 2.7 units of RBC products were used in 85 patients. In the autologous transfusion group more than 2 techniques of preoperative deposit, intraoperative autotansfusion by cell saver, acute normovolemic hemodilution, and postoperative autotransfusion were used, and 3.6 +/- 2.4 units of RBC products were infused to 49 out of 239 patients (P < 0.001). A postoperative hematoma occured in 2 patients after a homologous transfusion but there were no cases in autologous transfusions. CONCLUSION: Consequently much of the homologous transfusion could be saved by using an autologous transfusion, and smaller amounts of postoperative drainge occured, so the author could confirm the benefit of autologous transfusion.