A systematic review and meta-analysis published in the European Spine Journal reports that perioperative use of glucagon-like peptide-1 receptor agonists was associated with lower odds of failed fusion after anterior cervical discectomy and fusion. Evidence on every other complication the authors looked at came back inconsistent.

GLP-1 receptor agonists are the drug class prescribed for type 2 diabetes and obesity, and the authors note their metabolic, anti-inflammatory and osteogenic effects raise questions about how they interact with spinal fusion. Anterior cervical discectomy and fusion, or ACDF, is a common neck operation in which a damaged disc is removed and the adjacent vertebrae are fused. Pseudarthrosis is the term for that fusion failing to knit.

Key results

The review pooled eight retrospective cohort studies covering 311,402 ACDF patients, of whom 8,182 were GLP-1RA users matched to non-users. Random-effects meta-analysis found significantly lower odds of pseudarthrosis among the GLP-1RA group at 6 months (OR 0.60, 95% CI 0.52 to 0.71), 12 months (OR 0.62, 95% CI 0.53 to 0.73), and 24 months (OR 0.67, 95% CI 0.57 to 0.79).

Heterogeneity across those three time points was low to moderate, which is worth noting in a pooled analysis of retrospective data. The consistency of the effect across all three intervals is the most interesting thing in the paper.

Where the signal stops

For reoperation, dysphagia, deep vein thrombosis and readmission, the authors describe the findings as heterogeneous and inconsistent across studies. That is not a negative result, it is an absence of one, and the review does not attempt to paper over it.

This is a question the spine literature had not addressed directly before. The authors say no systematic review had previously looked specifically at GLP-1RA exposure in ACDF, which makes even an inconclusive answer on secondary outcomes useful.

Limitations

Every included study was retrospective and observational, and the authors classify the work as Level III evidence. Association is not causation here, and matched cohorts cannot rule out that patients prescribed these drugs differ from those who are not in ways the data does not capture.

The authors conclude that prospective studies are required to further clarify the impact of GLP-1RA use on ACDF outcomes.

Bottom line

Perioperative GLP-1RA use was associated with lower odds of pseudarthrosis across three follow-up windows in a large pooled sample. Everything else about how these drugs interact with cervical fusion surgery remains unsettled.