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Association between antidepressant use and pseudarthrosis following spinal fusion: a systematic review and
Nicholas Frappa1, Morgan Dillon1, Danil Chernov1
1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA.
Background Context:
Pseudarthrosis remains a clinically important complication following spinal fusion. Antidepressants are commonly prescribed among patients undergoing spinal arthrodesis, and serotonergic signaling plays a recognized role in bone metabolism. Whether antidepressant use influences fusion outcomes remains uncertain.
Purpose:
To evaluate the association between antidepressant use and pseudarthrosis following spinal fusion, with prespecified subgroup analyses of serotonergic antidepressants and by spinal region.
Study Design/Setting:
Systematic review and meta-analysis.
Patient Sample:
A total of 37,554 adult patients (≥18 years) undergoing cervical or lumbar spinal fusion across 5 observational studies.
Outcome Measures:
Physiologic measures-radiographic nonunion, clinically diagnosed pseudarthrosis, or revision surgery for pseudarthrosis.
Methods:
A systematic search of PubMed, Embase, and Web of Science was performed from database inception through the final search date. Eligible studies compared antidepressant-exposed patients with unexposed controls and reported pseudarthrosis or nonunion outcomes. Random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by spinal region and serotonergic antidepressant exposure.
Results:
A total of 5 studies met inclusion criteria. In the primary analysis including all antidepressant classes, antidepressant use was associated with increased odds of pseudarthrosis (OR 1.53, 95% CI: 1.17-2.01; p=.002), with substantial heterogeneity (I²=75.7%). In the serotonergic antidepressant subgroup (n=8,572), exposure was associated with more than a 2-fold increase in odds of pseudarthrosis (OR 2.26, 95% CI: 1.18-4.33; p=.014). Directionally consistent associations were observed in both cervical and lumbar fusion cohorts.
Conclusions:
Antidepressant use is associated with increased odds of pseudarthrosis following spinal fusion, with a stronger association observed among serotonergic agents. These findings support incorporating antidepressant exposure into preoperative risk stratification and patient counseling.
