Glucagon-like peptide-1 receptor agonist use and clinical outcomes after posterior cervical spinal fusion for degenerative pathologies: A large cohort retrospective analysis

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as potentially impactful agents in improving spinal fusion outcomes. While several recent studies have investigated the effect of these agents on lumbar spinal procedures, the current evidence of the impact of these agents on cervical spinal fusion is limited. This study aims to investigate the impact of GLP-1RA use on perioperative clinical outcomes of posterior cervical spinal fusion. Methods: This analysis queried the TriNetX Research Network to identify patients receiving posterior cervical spinal fusion for degenerative pathology. Patients on GLP-1RAs for at least 12 weeks prior to the surgery were compared to patients who were never on GLP-1RAs. Propensity score matching (1:1) was performed for preoperative clinical characteristics and prior spine procedures. Investigated outcomes included postoperative pseudoarthrosis, readmission, reoperation, cervicalgia, radiculopathy, myelopathy, mortality, cerebrospinal fluid leak, infection, and implant failure at 1-year follow-up. Results: A total of 737 patients with preoperative GLP-1RA use and 18,882 patients with no GLP-1RA use were identified. Prior to propensity score matching, patients on GLP-1RAs had a significantly higher risk of postoperative radiculopathy (p<.001), infection (p=.013), and readmission (p<.001), with a significantly reduced risk of pseudoarthrosis (p=.002). After propensity score matching, the risk of radiculopathy remained significantly elevated in the GLP-1RA cohort (hazard ratio: 1.367, 95% CI: 1.110-1.684, p=.003). The incidence of pseudoarthrosis remained significantly reduced in the GLP-1RA cohort (2.7% vs. 5.2%, p=.019), while a reduced risk of pseudoarthrosis trended toward significance (hazard ratio: 0.586, 95% CI: 0.336-1.022, p=.057). Conclusions: Preoperative GLP-1RA use was associated with increased postoperative risk of radiculopathy and decreased rates of pseudoarthrosis. The findings from this investigation may help optimize medical and surgical decision-making for posterior cervical spinal fusion patients on GLP-1 agonists.