GLP-1 receptor agonist use in elective lumbar spine surgery: Reduced pseudarthrosis rates and favorable safety profile

Background: Obesity and diabetes mellitus are well documented to to elevate perioperative risks in spine surgery; hence, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained popularity due to their efficacy in improving glycemic control and weight loss. However, their impact on lumbar spine-specific outcomes remains underexplored. This study evaluates associations between preoperative GLP-1 RA use and postoperative outcomes in patients undergoing elective lumbar spine surgery. Methods: A retrospective cohort analysis of 5722 patients undergoing elective lumbar spine surgery was conducted using data from the TriNetX database. Patients were categorized into two cohorts: (1) GLP-1 RA users, defined by a documented prescription within six months prior to surgery, and (2) non-users. The cohorts were matched in a 1:1 ratio via propensity score matching based on age, BMI, diabetes status, and relevant comorbidities. Outcomes assessed included major medical complications within 90 days and mechanical complications (pseudarthrosis, foot drop, post-laminectomy syndrome, and reoperation rates) at 1- and 3-year follow-up intervals. Results: No significant differences were observed between the GLP-1 RA and control cohorts regarding rates of medical complications within the 90-day postoperative period. However, concerning mechanical complications, GLP-1 RA users demonstrated significantly lower rates of pseudarthrosis at 1 year (6.54% vs. 8.53%; RR: 0.79; 95% CI: 0.66-0.95; p < 0.05), an effect that persisted through the 3-year follow-up (8.88% vs. 10.77%; RR: 0.85; 95% CI: 0.73-0.99; p < 0.05). No statistically significant differences were observed in reoperation rates or other mechanical complications at either the 1-year or 3-year follow-up intervals. Conclusion: Preoperative GLP-1 RA use was not associated with increased short- or intermediate-term medical or mechanical complications following lumbar spine procedures. Notably, GLP-1 RA use correlated with reduced rates of pseudarthrosis at 1- and 3-year intervals. These findings support the safety and potential benefits of GLP-1 RAs in metabolically high-risk patients undergoing elective lumbar spine surgery.