The impact of proton pump inhibitor use on fusion rates following single-level lumbar spinal fusion surgery.

PURPOSE: Lumbar spinal fusion surgery is a common treatment for degenerative spinal conditions. While proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders, emerging evidence suggests that PPI use may negatively affect bone health, potentially influencing spinal fusion outcomes. This study evaluates the impact of postoperative proton pump inhibitor (PPI) use on fusion rates following single-level lumbar spinal fusion surgery.

METHODS

Data were obtained from the Global Collaborative Network on the TriNetX platform. Patients undergoing single-level lumbar fusion were identified using ICD and CPT codes. Propensity score matching was employed to balance demographics and comorbidities between PPI users and non-users. Postoperative PPI use was defined as continuous use for at least three months following surgery. Non-fusion was identified using ICD-10 code M96.0 at six months, one year, and two years post-surgery. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to assess the risk of pseudarthrosis.

RESULTS

The study included 3,857 PPI users and 4,4291 non-users, reduced to 3,847 in each group after propensity score matching. PPI users showed a significantly higher risk of non-fusion at six months (OR: 1.82, 95% CI: 1.54-2.16), one year (OR: 2.08, 95% CI: 1.78-2.44), and two years (OR: 2.33, 95% CI: 2.01-2.71) compared to non-users.

CONCLUSION

The study indicates that postoperative PPI use is linked to a higher risk of non-fusion after lumbar spinal fusion surgery. Clinicians may need to weigh the benefits of postoperative PPI use against its potential impact on bone healing.