The Impact of Proton Pump Inhibitor Use on Fusion Rates Following Single-level Anterior Cervical Discectomy and Fusion

Study Design: Cohort study. Objective: This study explores how proton pump inhibitors (PPIs) affect fusion rates following anterior cervical discectomy and fusion (ACDF), using a large-scale data analysis. Background: ACDF is essential for treating cervical disc herniation leading to myelopathy and radiculopathy, involving disc removal and vertebral fusion, crucial for long-term stability and symptom relief. Notably, PPIs, which are commonly prescribed for acid-related disorders, have been linked to altered bone health and healing processes. Materials and Methods: Utilizing the TriNetX network database spanning from 2008 to 2023, we identified patients undergoing single-level ACDF, classified into cohorts based on PPI usage following ACDF. A 1:1 propensity score matching was performed to balance demographics and comorbidities between the two groups. The study focused on the incidence of non-fusion, indicated by the International Classification of Disease-10 code M96.0, within 6 months to 2 years postoperatively. Results: The initial cohort comprised 1269 PPI users and 23,932 non-users, adjusted to 1266 per group after matching. Postmatching analysis indicated minimal differences in demographics and comorbidities between the cohorts. Our results showed that postoperative PPI users have a significantly higher risk of non-fusion following single-level ACDF surgery at 1 year (odds ratio: 1.35, 95% CI: 1.05-1.73) and 2 years (odds ratio: 1.42, 95% CI: 1.11-1.81) follow-up. Conclusions: Our study showed a significant link between postoperative PPI use and increased long-term pseudarthrosis risk after ACDF surgery. These findings suggest careful consideration of PPI use in these patients.