DOI: 10.1097/brs.0000000000005773 ISSN: 0362-2436

Long-Term Mechanical Complications After Lumbar Fusion in Patients Receiving Tirzepatide vs Other GLP-1 Receptor Agonists

Ryan Wang, Humaira Islam, Arjuna Karikaran, William Zeng, Alexander T. Hong, Hannah Cho, Syed I. Khalid, Ankit I. Mehta
Show PDF Cite

Study Design.

Retrospective cohort study

Objective.

To compare short-term outcomes and long-term mechanical complications following lumbar fusion in patients receiving tirzepatide versus non-tirzepatide glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

Summary of Background Data.

GLP-1 RAs have demonstrated metabolic and anti-inflammatory effects that may influence postoperative recovery. Tirzepatide, a dual GLP-1/ glucose-dependent insulinotropic polypeptide (GIP), has shown greater metabolic efficacy than traditional GLP-1 RAs, though its impact on spinal fusion outcomes remains unclear.

Methods.

A retrospective cohort analysis was performed using the TriNetX Global Collaborative Network for adult patients undergoing lumbar fusion. Exposure was defined by tirzepatide or non tirzepatide GLP-1 RAs prescription within one year before surgery. Propensity score matching (1:1) was conducted using demographic and clinical covariates. Ninety-day complications and mechanical outcomes from 1-3 years were evaluated using risk ratios (RRs) with 95% confidence intervals (CIs).

Results.

After matching, ninety-day medical complications, hospitalizations and emergency department visits were similar between groups ( P >0.05). At one year, pseudoarthrosis (3.0% vs 3.8%), instrumentation failure (1.4% vs 1.7%), and revision surgery (1.3% vs 1.3%) were comparable between groups ( P >0.05). By two years, tirzepatide was associated with significantly lower pseudoarthrosis (3.1% vs 5.5%, RR 0.56, 95% CI 0.35–0.90, P =0.016) and instrumentation failure (1.5% vs 3.5%, RR 0.42, 95% CI 0.22–0.80, P =0.006), with similar revision rates. At three years, pseudoarthrosis (3.1% vs 6.0%, RR 0.51, 95% CI 0.32–0.82, P =0.005) and instrumentation failure (1.6% vs 3.7%, RR 0.43, 95% CI 0.23–0.79, P =0.005) remained significantly lower, while revision surgery remained nonsignificant.

Conclusion.

Tirzepatide was associated with comparable short-term safety and lower rates of long-term mechanical complications after lumbar fusion. These findings suggest differences in mechanical outcomes that emerge over extended follow-up and warrant prospective comparative evaluation.

More from our Archive