Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in Spinal Fusion: A Systematic Review

Area of Science:

• Orthopedics
• Pharmacology
• Evidence-Based Medicine

Background:

• Acid suppression medications, including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 blockers), are widely used.
• The impact of these medications on surgical outcomes, particularly spinal fusion, requires thorough investigation.

Purpose of the Study:

• To systematically review and evaluate the effect of PPIs and H2 blockers on spinal fusion success.
• To identify potential associations between acid suppression therapy and adverse spinal fusion outcomes like pseudarthrosis.

Main Methods:

• A systematic literature search was performed in PubMed (MEDLINE) for English-language studies from January 2000 to July 2025.
• Studies examining the relationship between PPIs, H2 blockers, and spinal fusion outcomes were included. Data extraction and screening were conducted by two independent reviewers.

Main Results:

• Five studies met the inclusion criteria, including retrospective cohort studies, an animal study, and a prospective study.
• Three clinical studies indicated higher rates of pseudarthrosis (failed fusion) in patients using PPIs post-spinal fusion.
• An animal model showed no significant impairment, and an H2 blocker study reported reduced inflammation without assessing osseous union.

Conclusions:

• Current evidence suggests a potential association between PPI use and impaired spinal fusion, especially in cervical and lumbar spine surgeries.
• H2 blockers appear to have a neutral skeletal impact, but direct evidence on spinal fusion is lacking.
• Further high-quality research, including prospective randomized trials, is necessary to establish a causal link between acid suppression and spinal fusion outcomes.