Association between glucagon-like peptide-1 receptor agonists and nonfusion risk after single-level anterior cervical discectomy and fusion

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating degenerative cervical spine diseases. Successful fusion is essential for spinal stability, while pseudarthrosis can lead to pain and revision surgery. Glucagon-like peptide-1 (GLP-1) drugs, used for type 2 diabetes (T2DM) and obesity, have demonstrated benefits in vascular and bone health.

Purpose: This study investigates whether perioperative GLP-1 drug use affects fusion rates in T2DM patients undergoing single-level ACDF.

Design: Retrospective cohort study.

Patient sample: T2DM patients undergoing single-level ACDF.

Outcome measurement: Risk of pseudarthrosis, identified using ICD-10 code M96.0, at 6 months, 1 year, and 2 years postoperatively.

Methods: A retrospective analysis was conducted using the TriNetX database, identifying T2DM patients who underwent single-level ACDF via CPT codes. Patients were categorized based on GLP-1 drug use within 6 months before or after surgery. A 1:1 propensity score matching (PSM) controlled for age, sex, race, and comorbidities.

Results: Before propensity score matching (PSM), 1,245 GLP-1 drug users and 13,519 nonusers were included. After matching, 1,242 patients remained in each group. At 6 months, the nonfusion rate was 7.9% in the GLP-1 drug group and 13.6% in the nonuser group (OR=0.55, 95% CI: 0.42-0.72, p<.001), indicating 45% lower odds of pseudarthrosis in GLP-1 drug users. This trend remained consistent at 1 year (8.8% vs 14.5%, OR=0.57, 95% CI: 0.44-0.74, p<.001) and 2 years postoperatively (10.0% vs 15.5%, OR=0.61, 95% CI: 0.48-0.78, p<.001), suggesting a sustained reduction in the risk of nonfusion with GLP-1 drug use.

Conclusions: Perioperative GLP-1 drug use is associated with a lower risk of pseudarthrosis in T2DM patients undergoing ACDF. These findings suggest a potential role for GLP-1 drugs in improving spinal fusion outcomes.

Keywords: Anterior cervical discectomy and fusion; Cervical spine surgery; Glucagon-like peptide-1 receptor agonists; Non-fusion; Pseudoarthrosis; Type 2 Diabetes Mellitus.