Background: Transfusion of blood is regarded as of key importance in the spinal procedure. In spite of increase in rate of spinal surgeries, the audit of blood transfusion throughout spinal procedures in regional traumatic centers is important. Therefore, the present study was undertaken to evaluate blood transfusion practices in adult spine surgeries and also determine the extent of utilization, wastage of blood products, and prescription of blood during spine surgery with the help of indices (C/T, %T, and TI) for assessing blood ordering. Materials and methods: A retrospective observational study among 130 patients was conducted to audit the blood transfusion practice during the intraoperative period for adult spine surgery over a period of 1 year. The rate of blood transfusion and indices of blood utilization were calculated. Results: Out of 510 blood units cross-matched for 130 study subjects, just 112 units were transfused to 60 cases, indicative of only 46.15% of cases required transfusions of blood. We observed that factors related to a greater chance of transfusion of blood were preoperative hemoglobin, indication of surgery, surgical approach, and region of spine by Chi-square. Of all of these variables, only indication of surgery was relevant in the multivariate model. The transfusion probability (%T), “transfusion index” (TI), and “cross-match transfusion (C/T) ratio” were 46.2, 0.86, and 4.5%, respectively. Conclusion: The independent factor associated with more number of blood transfusions was indication of surgery. Transfusion probability and TI in the present study are indicative of optimal utilization of blood. However, the high C/T ratio suggests the over cross-matching, which should be minimized in future.