Glucagon-like peptide-1 receptor agonist use and clinical outcomes after posterior cervical spinal fusion for degenerative pathologies: A large cohort retrospective analysis

Why This Matters

GLP-1 receptor agonists are increasingly used in patients who may also require spine surgery. As exposure to these medications becomes more common, clinicians need to understand whether preoperative use is associated with differences in postoperative outcomes.

This large retrospective analysis examined patients undergoing posterior cervical spinal fusion for degenerative pathology. The study specifically evaluated whether at least 12 weeks of preoperative GLP-1 receptor agonist use was associated with outcomes including pseudoarthrosis, radiculopathy, infection, readmission, reoperation, implant failure, and other postoperative complications.

What the Research Found

Using the TriNetX Research Network, investigators identified 737 patients with preoperative GLP-1 receptor agonist use and 18,882 patients who had never used these medications. The groups were then propensity-score matched for preoperative clinical characteristics and prior spine procedures.

After matching, GLP-1 receptor agonist use was associated with a higher postoperative risk of radiculopathy, while the observed incidence of pseudoarthrosis was lower among GLP-1 users.

KEY POINTS

• Postoperative radiculopathy remained more common after matching. During 1-year follow-up, patients using GLP-1 receptor agonists had an approximately 37% higher relative rate of postoperative radiculopathy than matched non-users.
• Pseudoarthrosis occurred less often in the GLP-1 group. The observed incidence was 2.7% with GLP-1 receptor agonist use versus 5.2% without use, an absolute difference of 2.5 percentage points.
• A separate time-to-event analysis pointed in the same direction for pseudoarthrosis but was less conclusive. The overall pattern suggested fewer pseudoarthrosis events among GLP-1 users, but that analysis did not provide equally clear evidence of a difference.
• Several differences were present before matching. Before propensity matching, GLP-1 users had higher rates of radiculopathy, infection, and readmission and a lower rate of pseudoarthrosis, underscoring the importance of accounting for baseline clinical differences between groups.
• The findings demonstrate association, not causation. This was a retrospective cohort analysis, so it cannot establish that GLP-1 receptor agonists directly caused either the higher radiculopathy rate or lower pseudoarthrosis incidence.