European Spine Journal - 2026-08-21 - Journal Article
The impact of testosterone replacement therapy on clinical outcomes after anterior cervical discectomy and fusion: a propensity-matched cohort study.
Ferdon RJ, Peller J, Hashmi SZ, Johnson JP, Ravinsky RA, Reitman CA, Silvestre J
Topics
Key Takeaway
TRT use prior to single-level ACDF is associated with 30% higher odds of pseudoarthrosis, 70% higher odds of adjacent segment disease, and 50% higher odds of cervical reoperation at five years compared to propensity-matched controls.
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Summary
This propensity-matched multi-institutional retrospective cohort study examined whether TRT exposure in the year prior to single-level ACDF affects short- and long-term surgical outcomes. At 30 days and 1 year, complication rates including dysphagia, dysphonia, and VTE were equivalent between TRT and non-TRT cohorts. At 5 years, TRT patients had significantly higher odds of pseudoarthrosis (OR 1.3), adjacent segment disease (OR 1.7), and cervical reoperation (OR 1.5).
Key Limitation
TRT dose, formulation, serum testosterone levels, and treatment compliance are not captured, making it impossible to determine whether the observed risk is a class effect or driven by supraphysiologic dosing.
Original Abstract
PURPOSE
The purpose of this study was to characterize the short- and long-term outcomes following anterior cervical discectomy and fusion (ACDF) among patients on testosterone replacement therapy (TRT).
METHODS
A multi-institutional, propensity-matched retrospective cohort study was conducted on an electronic medical record database for patients undergoing single-level ACDF. The cohort of interest was TRT exposure one-year prior to surgery. Exclusion criteria included prior cervical spine surgery, < 18 years old, and a history of spine neoplasms, trauma, inflammatory, or infectious bone conditions. Odds ratios with 95% confidence intervals for complications were calculated at thirty-days, one-, two-, and five-years.
RESULTS
There were 862 patients included in each single-level ACDF cohort and most were male (88.2%). At thirty days, there were similar rates of medical complications in the TRT and non-TRT cohorts (P > 0.05). At one-year, there were similar rates of dysphagia, dysphonia, and venous thromboembolism between the two cohorts (P > 0.05). At five-years, patients in the TRT cohort had higher odds of pseudoarthrosis (OR: 1.3, 95% CI: 1.0-1.8; P = 0.049) and adjacent segment disease (OR: 1.7, 95% CI: 1.0-2.8, P = 0.037) compared to patients in the non-TRT cohort. Additionally, patients in the TRT cohort had higher rates of cervical spine reoperation (OR: 1.5, 95% CI: 1.1-2.2; P = 0.020) at five-years.
CONCLUSION
TRT was associated with higher rates of pseudoarthrosis, adjacent segment disease, and cervical spine reoperation at five years following ACDF. These results can be used to inform patients on TRT regarding long-term risks following ACDF.