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Are GLP-1 Receptor Agonists Safe in Spine Surgery: A Systematic Review.
Iyan Younus1, Rafael Garcia de Oliveira1, Takeshi Fujii1
1Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA.
Spine
|July 28, 2025
Summary
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) show mixed results in spine surgery outcomes. Further prospective studies are needed to clarify their impact on complications and recovery.
Area of Science:
- Endocrinology
- Neurosurgery
- Pharmacology
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for glycemic control and weight loss.
- Limited data exists on the safety and efficacy of GLP-1 RAs in the context of spine surgery.
Purpose of the Study:
- To systematically review the impact of GLP-1 RAs on spine surgery outcomes.
- To assess general benefits and adverse effects of GLP-1 RAs.
- To discuss perioperative management considerations for patients on GLP-1 RAs undergoing spine surgery.
Main Methods:
- Systematic literature review using PubMed and Embase.
- Keywords included GLP-1 RAs, semaglutide, spine surgery, spinal fusion, and specific spinal regions (cervical, thoracic, lumbar).
- Inclusion criteria focused on studies assessing GLP-1 RA utilization in spine surgery.
Main Results:
- Ten retrospective studies were included, yielding heterogeneous and contradictory findings.
- Results for medical complications, operative outcomes, readmissions, and pseudarthrosis varied, with some studies reporting favorable, equivocal, or adverse outcomes in the GLP-1 RA cohort.
- Four studies indicated lower odds of pseudarthrosis with GLP-1 RA use, while one study reported higher odds.
Conclusions:
- Current evidence from retrospective studies on GLP-1 RAs in spine surgery is mixed and inconclusive.
- Potential unmeasured confounders limit the interpretation of existing data.
- Prospective studies are essential to establish causal relationships and better understand the perioperative impact of GLP-1 RAs in spine surgery.
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