The impact of semaglutide on fusion rates following posterior lumbar fusion surgery in patients with type 2 diabetes

May 28, 2025International journal of surgery (London, England)

Semaglutide and its link to bone healing after lower back fusion surgery in people with type 2 diabetes

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Abstract

Semaglutide use is associated with lower rates of pseudarthrosis following posterior lumbar fusion surgery in patients with type 2 diabetes mellitus.

Pseudarthrosis rates were 8.0% in semaglutide users compared to 13.1% in non-users at 6 months.
At 1 year, pseudarthrosis rates were 8.9% for semaglutide users versus 14.0% for non-users.
At 2 years, 10.1% of semaglutide users experienced pseudarthrosis compared to 15.7% of non-users.
Odds ratios indicate a reduced risk of pseudarthrosis for semaglutide users at 6 months (OR: 0.58), 1 year (OR: 0.60), and 2 years (OR: 0.60).

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BACKGROUND: Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist used in managing type 2 diabetes mellitus (T2DM), has demonstrated cardiovascular and glycemic benefits. However, its influence on surgical outcomes, particularly spinal fusion, remains unclear. This study aims to evaluate the association between semaglutide use and pseudarthrosis rates following posterior lumbar fusion surgery in patients with T2DM.

METHODS: Data were retrieved from the TriNetX Global Collaborative Network, which includes de-identified records from 117 healthcare systems. T2DM patients who underwent posterior lumbar fusion were identified using CPT codes, and semaglutide exposure was determined preoperatively. Patients were divided into semaglutide and non-semaglutide groups, with 1:1 propensity score matching applied. Pseudarthrosis was identified using ICD-10 code M96.0.

RESULTS: After matching, baseline characteristics were well-balanced between groups with 884 patients in each group. Semaglutide users had significantly lower rates of pseudarthrosis at 6 months (8.0% vs. 13.1%, OR: 0.58; 95% CI: 0.42-0.79), 1 year (8.9% vs. 14.0%, OR: 0.60; 95% CI: 0.45-0.81), and two years (10.1% vs. 15.7%, OR: 0.60; 95% CI: 0.45-0.80) compared to non-users.

CONCLUSIONS: Semaglutide use is associated with a reduced risk of pseudarthrosis following posterior lumbar fusion in patients with T2DM. Further studies are warranted to elucidate the mechanisms underlying this potential benefit and to assess its implications in broader patient populations.

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The impact of semaglutide on fusion rates following posterior lumbar fusion surgery in patients with type 2 diabetes

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