Resident Physician Icahn School of Medicine at Mount Sinai New York, NY, US
Introduction: The influence of menopausal hormone therapy (MHT) on the postoperative outcomes of patients undergoing transforaminal lumbar interbody fusion (TLIF) remains uncertain. This study aims to examine the rates of pseudarthrosis in female patients undergoing TLIF, categorized into MHT and non-MHT groups.
Methods: This international multicenter cohort study used data spanning from October 25, 2010 to October 25, 2024 from the global health network TriNetX. One-to-one propensity score matching for age, sex, race, BMI, and comorbidities was conducted to balance cohorts. The rates of pseudarthrosis were then assessed within the six-month, one-year, and two-year postoperative follow-up periods.
Results: A total of 783 female patients who underwent single-level TLIF and were post-menopausal (mean [SD] age, 53.2 [4.8] years) were included in the study. Among these individuals, 355 were identified as taking MHT. Following propensity score matching, there were 324 patients in each cohort. Patients that took MHT had lower odds of developing pseudarthrosis six months [odds ratio (OR): 0.57, 95% confidence interval (CI): (0.37,0.89)], one year [OR: 0.59, 95% CI: (0.39,0.91)], and two years (OR: 0.61, 95% CI: (0.40,0.92)) following a TLIF.
Conclusion : In this cohort study, postmenopausal TLIF patients taking MHT in the preoperative period had reduced rates of pseudarthrosis compared to postmenopausal TLIF patients not taking MHT. These findings suggest a potential therapeutic benefit of MHT in enhancing spinal fusion outcomes in postmenopausal women and warrant further prospective studies to confirm these results and explore the underlying mechanisms.