Are GLP-1 Receptor Agonists Safe in Spine Surgery

STUDY DESIGN: Systematic review. OBJECTIVE: The objective of this study is to: 1) systematically review Glucagon-like peptide-1 receptor agonists (GLP-1 RA) impact on spine surgery outcomes 2) review general benefits and adverse effects, and 3) discuss considerations for perioperative management. SUMMARY OF BACKGROUND DATA: GLP-1 RAs have gained popularity given their significant benefits in glycemic control and weight loss. There remains a paucity of data on the safety of GLP-1 RAs in spine surgery. METHODS: A literature review using PubMed and Embase with the following keywords was performed: GLP-1 RAs; semaglutide; spine surgery; spinal fusion; interbody fusion; cervical; thoracic; lumbar. A systematic review was conducted to assess GLP-1 RAs utilization in spine surgery. RESULTS: Ten retrospective studies met inclusion criteria producing mixed results on the impact of GLP-1 RAs in spine surgery. Studies had varying follow up and wide heterogeneity in methodology with different surgical procedures and outcomes studied. In regard to medical complications, 1 study reported favorable outcomes, 1 reported equivocal outcomes, and 1 reported worse outcomes in the GLP-1 RA cohort. In regard to operative outcomes, 2 studies were favorable, 1 study was equivocal, and 1 study reported adverse outcomes. For readmissions, the GLP-1 RA cohort had positive outcomes in 1 study and equivocal outcomes in 4 studies. In regard to pseudarthrosis, the GLP-1 RA cohort had lower odds of pseudarthrosis in 4 studies and higher odds in 1 study. CONCLUSION: This review highlights the current understanding of GLP-1 RA's impact on spine surgery. Retrospective studies demonstrate mixed and contradictory results on the impact of GLP-1 RAs on medical complications, operative outcomes, readmission, and pseudarthrosis. These studies are limited by potential unmeasured confounders and do not establish a causal relationship highlighting the need for future prospective studies to better understand the impact of GLP-1 RAs on spine surgery.