This prospective clinical study evaluates the impact of intraoperative cell-salvaged blood transfusion (SBT) on long-term clinical outcomes in metastatic spine tumour surgery (MSTS). Comparing SBT with allogeneic blood transfusion (ABT) and no transfusion (NBT), the study finds no significant difference in overall survival or tumour progression over four years. The findings support SBT as a viable alternative to ABT, reducing risks and dependency on donor blood.