The Impact of Isolated Baseline Cannabis Use on Outcomes Following Thoracolumbar Spinal Fusion: A Propensity Score-Matched Analysis

Neil V Shah; Joshua D Lavian; Cameron R Moattari; Hassan Eldib; George A Beyer; David H Mai; Vincent Challier; Peter G Passias; Renaud Lafage; Virginie Lafage; Frank J Schwab; Carl B Paulino; Bassel G Diebo

The Impact of Isolated Baseline Cannabis Use on Outcomes Following Thoracolumbar Spinal Fusion: A Propensity Score-Matched Analysis

Iowa Orthop J. 2022 Jun;42(1):57-62.

Authors

Affiliations

¹ Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA.
² Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Bordeaux, France.
³ Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA.
⁴ Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
⁵ Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA.
⁶ Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA.
⁷ Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.

PMID: 35821925
PMCID: PMC9210439

Abstract

Background: There is limited literature evaluating the impact of isolated cannabis use on outcomes for patients following spinal surgery. This study sought to compare 90-day complication, 90-day readmission, as well as 2-year revision rates between baseline cannabis users and non-users following thoracolumbar spinal fusion (TLF) for adult spinal deformity (ASD).

Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried between January 2009 and September 2013 to identify all patients who underwent TLF for ASD. Inclusion criteria were age ≥18 years and either minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Cohorts were created and propensity score-matched based on presence or absence of isolated baseline cannabis use. Baseline demographics, hospital-related parameters, 90-day complications and readmissions, and two-year revisions were retrieved. Multivariate binary stepwise logistic regression identified independent outcome predictors.

Results: 704 patients were identified (n=352 each), with comparable age, sex, race, primary insurance, Charlson/Deyo scores, surgical approach, and levels fused between cohorts (all, p>0.05). Cannabis users (versus non-users) incurred lower 90-day overall and medical complication rates (2.4% vs. 4.8%, p=0.013; 2.0% vs. 4.1%, p=0.018). Cohorts had otherwise comparable complication, revision, and readmission rates (p>0.05). Baseline cannabis use was associated with a lower risk of 90-day medical complications (OR=0.47, p=0.005). Isolated baseline cannabis use was not associated with 90-day surgical complications and readmissions, or two-year revisions.

Conclusion: Isolated baseline cannabis use, in the absence of any other diagnosed substance abuse disorders, was not associated with increased odds of 90-day surgical complications or readmissions or two-year revisions, though its use was associated with reduced odds of 90-day medical complications when compared to non-users undergoing TLF for ASD. Further investigations are warranted to identify the physiologic mechanisms underlying these findings. Level of Evidence: III.

Keywords: adult spinal deformity; cannabis; marijuana; outcomes; spine; substance use; thoracolumbar fusion.

MeSH terms

Adolescent
Adult
Cannabis*
Humans
Postoperative Complications / etiology
Propensity Score
Retrospective Studies
Spinal Fusion* / adverse effects