Preoperative Gabapentinoid Use Is Associated With Increased Pseudoarthrosis Following Adult Spinal Deformity Surgery
Melissa Romoff, Shahabeddin Yazdanpanah, Ryan Beyer, Arthur Cowman, Emily Tse, Michael S. Kim, Don Young Park, Yu-Po Lee, Nitin Bhatia, Sohaib Hashmi, Hao-Hua Wu, Emily S. MillsStudy Design:
Retrospective propensity score-matched cohort study.
Objective:
To evaluate the association between preoperative gabapentinoid use postoperative pseudoarthrosis, reoperation, and medical complications following adult spinal deformity (ASD) surgery.
Summary of Background Data:
Gabapentinoids are increasingly prescribed for neuropathic and radicular pain and have demonstrated inhibitory effects on bone metabolism and spinal fusion formation in preclinical models. While prior studies have examined chronic gabapentinoid use in short-segment lumbar fusion, no study has evaluated their impact in ASD surgery, where construct length and baseline pseudoarthrosis are substantially greater.
Materials and Methods:
Adult patients undergoing ASD correction between 2015 and 2022 were identified using the TriNetX Research Network. Patients with preoperative gabapentinoid prescription within 90 days before surgery were compared with nonusers. Exclusion criteria included trauma, neoplasm, infection, prior fusion, revision surgery, and preoperative opioid use. One-to-one propensity score matching was performed on demographics, comorbidities, and medication use. Primary outcomes included pseudoarthrosis and reoperation at one-year, two-year, and three-year follow-up. Secondary outcomes included 90-day medical complications, including venous thromboembolism, surgical site infection, acute kidney injury, pneumonia, stroke, and myocardial infarction.
Results:
After propensity score matching, 477 gabapentinoid users were matched to 477 nonusers. Baseline demographics and surgical complexity were well balanced between cohorts. No significant differences were observed in 90-day medical complications or reoperation rates at any time point. However, preoperative gabapentinoid use was associated with significantly increased pseudoarthrosis rates at all follow-up intervals. Pseudoarthrosis occurred in 18.18%
Conclusion:
Preoperative gabapentinoid use was associated with an approximately two-fold increased risk of pseudoarthrosis following ASD surgery without corresponding increases in perioperative complications or reoperation. These findings suggest gabapentinoid exposure may represent an underrecognized modifiable risk factor for failed fusion in ASD surgery and warrants prospective investigation.