HomeCannabis MedicineCannabis Use is Associated with Higher Rates of Pseudarthrosis Following TLIF: A Multi-Institutional Matched-Cohort Study

Cannabis Use is Associated with Higher Rates of Pseudarthrosis Following TLIF: A Multi-Institutional Matched-Cohort Study

July 7, 2023

Spine (Phila Pa 1976). 2023 Jul 3. doi: 10.1097/BRS.0000000000004768. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort.

OBJECTIVE: To compare the rates of pseudarthrosis in patients undergoing 1-3 level Transforaminal Lumbar Interbody Fusion (TLIF) procedures between cannabis users and non-cannabis users.

SUMMARY OF BACKGROUND DATA: Recreational use of cannabis is common, though it remains poorly studied and legally ambiguous in the United States. Patients with back pain may turn to adjunctive use of cannabis to manage their pain. However, the implications of cannabis use on the achievement of bony fusion are not well-characterized.

METHODS: Patients who underwent 1-3 level TLIF for degenerative disc disease (DDD) or degenerative spondylolisthesis (DS) between 2010-2022 were identified using the PearlDiver Mariner all-claims insurance database. Cannabis users were identified with ICD 10 code F12.90. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with pseudarthrosis in a linear regression model. The primary outcome measure was development of pseudarthrosis within 24 months after 1-3 level TLIF. The secondary outcomes were the development of all-cause surgical complications as well as all-cause medical complications.

RESULTS: 1:1 exact matching resulted in two equal groups of 1,593 patients who did or did not use cannabis and underwent 1-3 level TLIF. Patients who used cannabis were 80% more likely to experience pseudarthrosis compared to patients who do not (RR 1.816, 95% CI 1.291-2.556, P<0.001). Similarly, cannabis use was associated with significantly higher rates of all-cause surgical complications (RR 2.350, 95% CI 1.399-3.947, P=0.001) and all-cause medical complications (RR 1.934, 95% CI 1.516-2.467, P<0.001).

CONCLUSION: After 1:1 exact matching to control for confounding variables, the findings of this study suggest that cannabis use is associated with higher rates of pseudarthrosis, as well as higher rates of all-cause surgical and all-cause medical complications. Further studies are needed to corroborate our findings.

LEVEL OF EVIDENCE: III.

PMID:37417709 | DOI:10.1097/BRS.0000000000004768

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About The Author

Patrick Blanchard MD

Meet Dr. Blanchard Dr. Blanchard’s medical practice is an embodiment of Integrative health which brings conventional and complementary approaches together in a coordinated way. Conveniently located in sunny Florida and over the internet with ValiseMD’s secure HIPPA compliant telXmed servers. Since 1994, patients with a wide range of challenging medical problems have achieved optimum health using the best of natural medicine, judiciously combined with high-tech innovations. Breakthroughs are often achieved even after patients have consulted mainstream specialists and holistic practitioners. Dr. Blanchard is founder and CEO of ValiseMD, Inc. He is board certified in Family Medicine since 1994 and awarded Fellow of the American Academy of Family Physicians in 2001. He received the ‘Teacher of the Year’ award from the University of Kansas School of Medicine at completion of his residency in Family Medicine. He completed a fellowship at Wake Forest University in the field of vascular neurosonology. He holds a medical patent in the field of Gastroenterology. He holds an unrestricted license to practice medicine and surgery in Florida. He started his medical career as a Emergency Medical Technician, then as a Paramedic and later a Medical Doctor.