Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH.
University of Texas Southwestern Medical School, Dallas, TX.
Spine (Phila Pa 1976). 2024 Mar 15;49(6):412-418. doi: 10.1097/BRS.0000000000004768. Epub 2023 Jul 3.
This was a retrospective cohort study.
To compare the rates of pseudarthrosis in patients undergoing 1 to 3 level transforaminal lumbar interbody fusion (TLIF) procedures between cannabis users and noncannabis users.
Recreational 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.
Patients 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.
A 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).
After 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.
这是一项回顾性队列研究。
比较大麻使用者和非大麻使用者在接受 1 至 3 个节段经椎间孔腰椎体间融合术（TLIF）治疗的患者中假关节形成的发生率。
在美国，娱乐性使用大麻很常见，但研究甚少，法律上也不明确。有背痛的患者可能会转而使用大麻来缓解疼痛。然而，大麻使用对实现骨融合的影响尚未得到很好的描述。
使用 PearlDiver Mariner 全民保险数据库，确定 2010 年至 2022 年间接受 1 至 3 个节段 TLIF 治疗退行性椎间盘疾病或退行性脊椎滑脱的患者。大麻使用者的 ICD 10 代码为 F12.90。排除因肿瘤、创伤或感染等非退行性病变接受手术的患者。使用线性回归模型中与假关节形成显著相关的人口统计学因素、合并症和手术因素进行 1:1 精确匹配。主要结局指标为 1 至 3 个节段 TLIF 后 24 个月内发生假关节形成。次要结局指标为所有原因手术并发症和所有原因医疗并发症的发生。
1:1 精确匹配产生了两组各 1593 名接受 1 至 3 个节段 TLIF 治疗且使用或不使用大麻的患者。与不使用大麻的患者相比，使用大麻的患者发生假关节的可能性高出 80%[相对风险（RR）：1.816，95%置信区间（CI）：1.291-2.556，P <0.001]。同样，大麻使用与更高的所有原因手术并发症发生率（RR：2.350，95% CI：1.399-3.947，P =0.001）和所有原因医疗并发症发生率（RR：1.934，95% CI：1.516-2.467，P <0.001）显著相关。
在进行 1:1 精确匹配以控制混杂变量后，本研究的结果表明，大麻使用与更高的假关节形成率以及更高的所有原因手术和所有原因医疗并发症发生率相关。需要进一步的研究来证实我们的发现。
