TY - JOUR
T1 - A retrospective cohort analysis of the effects of renin-angiotensin system inhibitors on spinal fusion in ACDF patients
AU - Perdomo-Pantoja, Alexander
AU - Shamoun, Feras
AU - Holmes, Christina
AU - Ishida, Wataru
AU - Ramhmdani, Seba
AU - Cottrill, Ethan
AU - Bydon, Ali
AU - Lo, Sheng fu L.
AU - Theodore, Nicholas
AU - Witham, Timothy F.
N1 - Funding Information:
The authors would like to acknowledge research funding from the Gordon & Marylin Macklin Foundation.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/8
Y1 - 2019/8
N2 - BACKGROUND CONTEXT: Recently, preclinical and clinical studies suggest an association between renin-angiotensin system (RAS) blockers and bone healing, particularly in the context of osteoporotic bone fractures. PURPOSE: To determine the correlation between the use of RAS inhibitors and fusion outcomes and neurologic status in anterior cervical discectomy and fusion (ACDF) surgery. STUDY DESIGN: Retrospective observational study. PATIENT SAMPLE: Patients who underwent ACDF for degenerative disorders. OUTCOME MEASURES: Spinal fusion status and neurologic function (modified Japanese Orthopedic Association [mJOA] and Nurick grading scales). METHODS: A retrospective chart review was performed, including 200 patients who underwent ACDF for degenerative disorders with 1-year minimum follow-up. Demographic data, comorbidities, antihypertensive medication, neurologic examination, and fusion status were collected. Spinal fusion was assessed via plain cervical x-ray, resorting to dynamic radiographs and/or computer tomography (CT) in cases of uncertainty. Preoperative mJOA and Nurick scores and recovery rates were calculated to determine neurologic status. RESULTS: Of the 200 patients (42.5% females, 57.5% males, median age of 53.7 years), 82 hypertensive patients were identified. Seventy-seven (93.9%) were taking antihypertensive medication as follows: 36.4% angiotensin-II receptor blockers (ARBs), 35.1% angiotensin-converting enzyme inhibitors (ACEIs), and the remaining patients were taking other medication. In the analysis of fusion rates, patients treated with ARBs exhibited a higher fusion rate, while those treated with ACEIs displayed a lower fusion rate compared to untreated nonhypertensive patients (p =.04 and.02, respectively). The difference in fusion rates between ARBs and ACEIs was also significant, with the former displaying higher rates (p <.001). Smoking exhibited a negative correlation with spinal fusion (p <.001). In the multivariate analysis, ARBs remained an independent factor for successful fusion (p =.02), while smoking remained a risk factor for failed fusion (p =.002). In the neurologic examination, ACEIs, hypertension status, and older age correlated with lower modified Japanese Orthopedic Association (mJOA) recovery rates (p =.001, <.001, and <.001, respectively) in the univariate analysis. CONCLUSIONS: In ACDF patients, we observed that ARBs were associated with higher fusion rates. Conversely, ACEIs and smoking were related to failed fusion. Prospective case-control studies are needed to confirm these RAS inhibitors effects on spinal fusion.
AB - BACKGROUND CONTEXT: Recently, preclinical and clinical studies suggest an association between renin-angiotensin system (RAS) blockers and bone healing, particularly in the context of osteoporotic bone fractures. PURPOSE: To determine the correlation between the use of RAS inhibitors and fusion outcomes and neurologic status in anterior cervical discectomy and fusion (ACDF) surgery. STUDY DESIGN: Retrospective observational study. PATIENT SAMPLE: Patients who underwent ACDF for degenerative disorders. OUTCOME MEASURES: Spinal fusion status and neurologic function (modified Japanese Orthopedic Association [mJOA] and Nurick grading scales). METHODS: A retrospective chart review was performed, including 200 patients who underwent ACDF for degenerative disorders with 1-year minimum follow-up. Demographic data, comorbidities, antihypertensive medication, neurologic examination, and fusion status were collected. Spinal fusion was assessed via plain cervical x-ray, resorting to dynamic radiographs and/or computer tomography (CT) in cases of uncertainty. Preoperative mJOA and Nurick scores and recovery rates were calculated to determine neurologic status. RESULTS: Of the 200 patients (42.5% females, 57.5% males, median age of 53.7 years), 82 hypertensive patients were identified. Seventy-seven (93.9%) were taking antihypertensive medication as follows: 36.4% angiotensin-II receptor blockers (ARBs), 35.1% angiotensin-converting enzyme inhibitors (ACEIs), and the remaining patients were taking other medication. In the analysis of fusion rates, patients treated with ARBs exhibited a higher fusion rate, while those treated with ACEIs displayed a lower fusion rate compared to untreated nonhypertensive patients (p =.04 and.02, respectively). The difference in fusion rates between ARBs and ACEIs was also significant, with the former displaying higher rates (p <.001). Smoking exhibited a negative correlation with spinal fusion (p <.001). In the multivariate analysis, ARBs remained an independent factor for successful fusion (p =.02), while smoking remained a risk factor for failed fusion (p =.002). In the neurologic examination, ACEIs, hypertension status, and older age correlated with lower modified Japanese Orthopedic Association (mJOA) recovery rates (p =.001, <.001, and <.001, respectively) in the univariate analysis. CONCLUSIONS: In ACDF patients, we observed that ARBs were associated with higher fusion rates. Conversely, ACEIs and smoking were related to failed fusion. Prospective case-control studies are needed to confirm these RAS inhibitors effects on spinal fusion.
KW - Angiotensin-II receptor blockers
KW - Angiotensin-converting enzyme inhibitors
KW - Anterior cervical discectomy and fusion
KW - Cervical spondylosis
KW - Osteoblast
KW - Osteoclast
KW - Pseudarthrosis
KW - Renin-angiotensin system
KW - Spinal fusion
UR - http://www.scopus.com/inward/record.url?scp=85065859122&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065859122&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2019.04.017
DO - 10.1016/j.spinee.2019.04.017
M3 - Article
C2 - 31059820
AN - SCOPUS:85065859122
SN - 1529-9430
VL - 19
SP - 1354
EP - 1361
JO - Spine Journal
JF - Spine Journal
IS - 8
ER -