Perioperative GLP-1 Agonist Use and Reduced Pseudarthrosis Rates Following Single-Level ACDF: A Propensity-Matched Retrospective Cohort Study

Introduction: Pseudarthrosis is a common surgical complication following arthrodesis and is associated with poor clinical outcomes. The association between GLP-1 agonist use and pseudarthrosis has yet to be explored. The objective of this study is to examine the association of GLP-1 agonists with rates of pseudarthrosis in patients undergoing single-level anterior cervical discectomy and fusion (ACDF).

Methods: This national multicenter cohort study used data spanning from October 15, 2010 to October 15, 2022 from the global health network TriNetX. One-to-one propensity score matching for age, sex, race, comorbidities and A1c was conducted to balance cohorts. The rates of pseudarthrosis were then assessed within the six-month, one-year, and two-year post-surgical follow-up periods.

Results: A total of 27,799 patients who underwent single-level ACDF (mean [SD] age, 60 [13] years; 49% men, 45% women, and 6% unknown) were included in the study. Among these individuals, 492 were identified as GLP-1 agonist users. Following propensity score matching, there were 461 patients in each cohort. Patients that took a GLP-1 agonist had lower odds of developing pseudarthrosis six months [odds ratio (OR): 0.614, 95% confidence interval (CI): (0.421,0.895)], one year [OR: 0.615, 95% CI: (0.428,0.884)], and two years (OR: 0.642, 95% CI: (0.454,0.907)) following a ACDF procedure.

Conclusion : In this cohort study, ACDF patients who were prescribed GLP-1 agonists in the perioperative period had reduced rates of pseudarthrosis compared to ACDF patients without GLP-1 agonist prescriptions. These findings suggest a potential therapeutic benefit of GLP-1 agonists in enhancing spinal fusion outcomes and warrant further prospective studies to confirm these results and explore the underlying mechanisms.