The Impact of Proton Pump Inhibitors on Pseudarthrosis Rates Following Multi-Level Lumbar Fusion

Area of Science:

• Spine surgery outcomes
• Bone metabolism and healing

Background:

• Multi-level lumbar fusion has a high pseudarthrosis risk (up to 35%).
• Proton pump inhibitors (PPIs) are linked to impaired bone metabolism and increased pseudarthrosis in other spinal fusions.
• The effect of PPIs on multi-level lumbar fusion outcomes is largely unexplored.

Purpose of the Study:

• To evaluate the association between postoperative proton pump inhibitor (PPI) use and pseudarthrosis risk in patients undergoing multi-level lumbar fusion.
• To determine if PPIs represent a modifiable risk factor for spinal fusion nonunion in this high-risk population.

Main Methods:

• Retrospective cohort study of 9,608 adults undergoing elective ≥2-level lumbar fusion from the TriNetX database.
• Propensity score matching (1:1) balanced 15 covariates between PPI users (≥3 months postoperative) and non-users.
• Pseudarthrosis incidence assessed at 6 months, 1 year, and 3 years postoperatively.

Main Results:

• No significant pseudarthrosis risk increase at 6 months (17.9% vs. 16.2%; p=0.136).
• Significant pseudarthrosis risk increase at 1 year (20.3% vs. 16.5%; RR=1.23, p<0.001) and 3 years (22.0% vs. 18.9%; RR=1.16, p<0.01).
• Time-dependent increase in pseudarthrosis risk observed with continued PPI use.

Conclusions:

• Postoperative PPI use is significantly associated with increased long-term pseudarthrosis risk after multi-level lumbar fusion.
• PPIs may be a modifiable perioperative risk factor, necessitating careful consideration of prolonged PPI therapy.
• Optimizing PPI management could improve spinal fusion success rates.