European Spine Journal - 2026-08-08 - Journal Article; Review
Impact of glucagon-like peptide-1 receptor agonists on outcomes following anterior cervical discectomy and fusion: a systematic review and meta-analysis.
Duru DO, Lee DKR, Edmonds C, Abraham A, Peach Y, Louie PK
Topics
Key Takeaway
Perioperative GLP-1RA use was associated with 33–40% lower odds of pseudarthrosis following ACDF at 6, 12, and 24 months (OR 0.60–0.67).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This systematic review and meta-analysis asked whether perioperative GLP-1RA use alters ACDF outcomes, pooling 8 retrospective cohort studies via random-effects meta-analysis. GLP-1RA users demonstrated significantly lower pseudarthrosis odds at 6 months (OR 0.60), 12 months (OR 0.62), and 24 months (OR 0.67), with low-to-moderate heterogeneity (I² 16.6–39.1%). Outcomes including reoperation, dysphagia, DVT, and readmission showed inconsistent results across studies.
Key Limitation
All included studies are retrospective, making it impossible to distinguish whether the pseudarthrosis benefit is attributable to GLP-1RA osteogenic effects, improved glycemic control, weight reduction, or anti-inflammatory mechanisms.
Original Abstract
OBJECTIVE
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for type 2 diabetes mellitus and obesity. Their metabolic, anti-inflammatory, and osteogenic effects raise important questions regarding their influence on spinal fusion. To date, no systematic review has specifically investigated how GLP-1RAs influence outcomes following the common anterior cervical discectomy and fusion (ACDF). This study aimed to evaluate the association between perioperative GLP-1RA use and outcomes following ACDF.
METHODS
Following PRISMA guidelines, MEDLINE, Embase, PubMed, and the Cochrane Library were searched from inception to February 2026 for studies evaluating GLP-1RA exposure in the context of ACDF. Eligible studies included human observational cohort studies. Data were extracted independently by two reviewers.
RESULTS
Eight retrospective cohort studies analysing 311,402 ACDF patients were included, of whom 8,182 were GLP-1RA users matched to non-users. Random-effects meta-analysis demonstrated significantly lower odds of pseudarthrosis among GLP-1RA users at 6 months (OR = 0.60, 95% CI: 0.52 to 0.71; I² = 16.6%), 12 months (OR = 0.62, 95% CI: 0.53 to 0.73; I² = 39.1%), and 24 months (OR = 0.67, 95% CI: 0.57 to 0.79; I² = 34.9%). Findings for reoperation, dysphagia, deep vein thrombosis, and readmission were heterogeneous and inconsistent across studies.
CONCLUSION
Perioperative GLP-1RA use was associated with lower odds of pseudarthrosis. However, evidence regarding other postoperative complications remains inconclusive. Future prospective studies are required to further elucidate the impact of GLP-1RA use on ACDF outcomes.
LEVEL OF EVIDENCE
Level III, therapeutic study.