• Simon C Mears, Pamela A Lipsett, Myles D Brager, and Lee H Riley.
• R. Adams Cowley Shock Trauma Center, University of Maryland Medical Systems, Baltimore, USA.
• Spine. 2002 Nov 15; 27 (22): E482-4.

Study DesignA case of metformin-associated lactic acidosis after elective spinal surgery is reported.ObjectiveTo inform spinal surgeons of this potentially fatal side effect and make them aware that metformin should be stopped 48 hours before surgery.Summary Of Background DataMetformin is a commonly used oral hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus. A rare side effect of metformin is lactic acidosis, which has a 50% mortality rate. Risk factors for metformin-associated lactic acidosis include renal, hepatic, and cardiac failure. Two cases have been reported in postsurgical patients. No cases of this disorder have been reported after orthopedic procedures.MethodsA patient who developed metformin-associated lactic acidosis after cervical spinal fusion is presented.ResultsRecognition of the cause and aggressive medical management led to resolution of the lactic acidosis. Subsequent surgery was uneventful when metformin was discontinued more than 48 hours before surgery.ConclusionSpinal surgeons should be aware of this preventable, potentially fatal side effect and stop metformin 48 hours before surgery.

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