Effect of Cannabis Use on Revision Surgery After Lumbar Spine Fusion: A Systematic Review and Meta-Analysis

Lumbar arthrodesis is commonly required for a number of spinal pathologies. The increasing use of cannabis and its legalization in many countries has the potential to impact spine surgical outcomes. There is a scarcity of research on the association between cannabis use and the need for revision surgery after lumbar fusion. The purpose of this study is to evaluate the relationship between cannabis use and the need for revision surgery after lumbar arthrodesis.

A systematic review, utilizing a comprehensive search strategy, was implemented to identify relevant studies, focusing specifically on the association between cannabis use and the incidence of revision surgery following lumbar fusion procedures. The primary outcome was the need for revision surgery. A subsequent meta-analysis was then performed. Data were synthesized using odds ratios (ORs) and the Mantel-Haenszel method, with a random-effects model to account for between-study variability. In addition, heterogeneity was assessed using I² statistics, sensitivity analyses were conducted to evaluate the robustness of the findings, and potential publication bias was examined using funnel plots.

Five studies with a total of 9983 patients were included in the meta-analysis. Our analysis showed a significantly increased risk of revision surgery in patients with cannabis use compared with nonusers [OR: 2.27 (95% CI: 1.27-4.05)]. The high heterogeneity (I²=95%) suggests differeces in patient populations, definitions of cannabis use, and follow-up durations across the included studies.

Cannabis use is associated with a significantly increased risk of revision surgery after lumbar fusion. These findings highlight the importance of targeted preoperative counseling and postoperative monitoring.