The Impact of Proton Pump Inhibitors on Pseudarthrosis Rates Following Multi-Level Lumbar Fusion
Abstract
Background: Multi-level lumbar fusion carries exceptionally high pseudarthrosis risk, with reported rates reaching 35% in contemporary series; however, the impact of proton pump inhibitors (PPIs) on fusion outcomes remains underexplored in this high-risk population. Recent evidence associates PPIs with increased pseudarthrosis in single-level cervical and lumbar fusions, given their established links to impaired bone metabolism. This study is the first to evaluate their association, specifically in multi-level lumbar fusion, where extended fusion constructs and heightened biomechanical demands amplify biological vulnerability to pseudarthrosis.
Methods: This retrospective cohort study analyzed 9,608 adults undergoing elective ≥2-level posterior lumbar interbody fusion/transforaminal lumbar interbody fusion from the TriNetX database. The exposed cohort comprised patients with sustained postoperative PPI use (≥3 months), while controls had no PPI prescriptions. Rigorous 1:1 propensity score matching (PSM) balanced 15 covariates, including demographics (age, sex, race), comorbidities (diabetes, osteoporosis, gastroesophageal reflux disease), body mass index categories, and medication exposures (nonsteroidal anti-inflammatory drugs) between cohorts. Pseudarthrosis incidence was assessed at standardized 6-month, 1-year, and 3-year postoperative intervals. Statistical significance was defined as p<0.05.
Results: After PSM (n=2,739 per cohort), PPI users did not demonstrate a…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 9,608 participants or records.
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