• Xu Tao, Abhijith V Matur, Syed Khalid, Geet Shukla, Phillip Vorster, Kelly Childress, Rebecca Garner, Justin Gibson, Daryn Cass, Juan C Mejia Munne, Kyle McGrath, Natalie Ivey, Julia Garcia-Vargas, Andrew Wu, Seth Street, Jay Mehta, Louisa Onyewadume, Henry O Duah, Benjamin Motley, Joseph S Cheng, and Owoicho Adogwa.
• Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH.
• Spine. 2024 Mar 15; 49 (6): 412418412-418.

Study DesignThis was a retrospective cohort study.ObjectiveTo compare the rates of pseudarthrosis in patients undergoing 1 to 3 level transforaminal lumbar interbody fusion (TLIF) procedures between cannabis users and noncannabis users.Summary Of Background DataRecreational use of cannabis is common, though it remains poorly studied and legally ambiguous in the United States. Patients with back pain may turn to adjunctive use of cannabis to manage their pain. However, the implications of cannabis use on the achievement of bony fusion are not well-characterized.MethodsPatients who underwent 1 to 3 level TLIF for degenerative disc disease or degenerative spondylolisthesis between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Cannabis users were identified with ICD 10 code F12.90. Patients undergoing surgery for nondegenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with pseudarthrosis in a linear regression model. The primary outcome measure was development of pseudarthrosis within 24 months after 1 to 3 level TLIF. The secondary outcomes were the development of all-cause surgical complications as well as all-cause medical complications.ResultsA 1:1 exact matching resulted in two equal groups of 1593 patients who did or did not use cannabis and underwent 1 to 3 level TLIF. Patients who used cannabis were 80% more likely to experience pseudarthrosis compared with patients who do not [relative risk (RR): 1.816, 95% CI: 1.291-2.556, P <0.001]. Similarly, cannabis use was associated with significantly higher rates of all-cause surgical complications (RR: 2.350, 95% CI: 1.399-3.947, P =0.001) and all-cause medical complications (RR: 1.934, 95% CI: 1.516-2.467, P <0.001).ConclusionAfter 1:1 exact matching to control for confounding variables, the findings of this study suggest that cannabis use is associated with higher rates of pseudarthrosis, as well as higher rates of all-cause surgical and all-cause medical complications. Further studies are needed to corroborate our findings.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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