Document Type

Article

Publication Date

12-19-2025

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This article is the author’s final published version in World Neurosurgery, Volume 206, 2026, Article number 124751.

The published version is available at https://doi.org/10.1016/j.wneu.2025.124751. Copyright © 2025 The Author(s).

 

Abstract

BACKGROUND: Pseudarthrosis remains a significant complication of ACDF, contributing to patient morbidity and increased healthcare costs. Glucagon-like peptide-1 receptor agonists (GLP-1RA), widely prescribed for diabetes and obesity, have been shown to reduced odds of pseudoarthrosis after ACDF. However, it remains unclear whether these reductions meaningfully translate to reduced odds of subsequent cervical surgery.

METHODS: The TriNetX United States Collaborative Network was queried for patients who underwent single- or multi-level ACDF between 2013-2023. Patients with perioperative GLP-1RA use and propensity-score-matched controls without GLP-1RA use were compared for subsequent rates of pseudoarthrosis and cervical reoperation at 6-, 12-, and 24-month intervals. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated to determine differences in outcomes between cohorts.

RESULTS: Following matching, 1592 patients were included in each cohort. GLP-1RA users demonstrated significantly reduced pseudarthrosis rates at all time points: 6 months (8% vs. 12%; OR=0.702; 95%CI=0.555-0.888), 12 months (OR=0.730; 95%CI=0.582-0.915), and 24 months postoperatively (OR=0.788; 95% CI=0.634-0.979). Reoperation odds among ACDF/GLP-1RA patients were significantly reduced at 12 months (4% vs. 6%; OR=0.689; 95%CI=0.493-0.963) and 24 months postoperatively (5% vs. 7%; OR=0.692; 95%CI=0.512-0.934). There were no statistically significant differences in outcomes between GLP-1RA users undergoing single-level versus multi-level ACDF.

CONCLUSIONS: GLP-1RA use was associated with significantly reduced odds of pseudarthrosis by more than 20% and reoperation by more than 30% at 24 months following ACDF, suggesting that GLP-1RAs may improve postoperative outcomes in high-risk populations, offering a potential avenue for reducing complications and costs associated with ACDF.

LEVEL OF EVIDENCE: Level III, Retrospective cohort study.

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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Language

English

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