Impact of Glucagon-like Peptide-1 Receptor Agonists on Outcomes Following Anterior Cervical Discectomy and Fusion - systematic review and meta-analysis

Oct 22, 2026

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for type 2 diabetes mellitus and obesity, with potential metabolic, anti-inflammatory, and osteogenic effects that may affect spinal fusion after surgery. A systematic review and meta-analysis evaluated whether perioperative GLP-1RA exposure influences outcomes following anterior cervical discectomy and fusion (ACDF). MEDLINE, Embase, PubMed, and the Cochrane Library were searched per PRISMA for human observational cohorts up to February 2026.

LanguageEnglish

CategoryResearch & Report

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Pages9

Reading Time23 min

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Abstract

Introduction

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European Spine Journal (2026) 35:5263–5271 [https://doi.org/10.1007/s00586-026-10258-y](https://doi.org/10.1007/s00586-026-10258-y) REVIEW Impact of glucagon-like peptide-1 receptor agonists on outcomes following anterior cervical discectomy and fusion: a systematic review and meta-analysis Dave Osinachukwu Duru1 · David Kwan Ryung Lee1 · Chloe Edmonds1 · Aron Abraham2 · Younis Peach2 · Philip K. Louie3 Received: 3 March 2026 / Revised: 5 March 2026 / Accepted: 3 August 2026 / Published online: 8 August 2026 © The Author(s) 2026 Abstract Objective Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for type 2 diabetes mellitus and obesity. Their metabolic, anti-inflammatory, and osteogenic effects raise important questions regarding their influence on spinal fusion. To date, no systematic review has specifically investigated how GLP-1RAs influence outcomes following the common anterior cervical discectomy and fusion (ACDF). This study aimed to evaluate the association between perioperative GLP-1RA use and outcomes following ACDF. Methods Following PRISMA guidelines, MEDLINE, Embase, PubMed, and the Cochrane Library were searched from inception to February 2026 for studies evaluating GLP-1RA exposure in the context of ACDF. Eligible studies included human observational cohort studies. Data were extracted independently by two reviewers. Results Eight retrospective cohort studies analysing 311,402 ACDF patients were included, of whom 8,182 were GLP-1RA users matched to non-users. Random-effects meta-analysis demonstrated significantly lower odds of pseudarthrosis among GLP-1RA users at 6 months (OR =0.60, 95% CI: 0.52 to 0.71; I² = 16.6%), 12 months (OR =0.62, 95% CI: 0.53 to 0.73; I² = 39.1%), and 24 months (OR =0.67, 95% CI: 0.57 to 0.79; I² = 34.9%) . Findings for reoperation, dysphagia, deep vein thrombosis, and readmission were heterogeneous and inconsistent across studies. Conclusion Perioperative GLP-1RA use was associated with lower odds of pseudarthrosis. However, evidence regarding other postoperative complications remains inconclusive. Future prospective studies are required to further elucidate the impact of GLP-1RA use on ACDF outcomes. Level of evidence Level III, therapeutic study. Keywords Anterior cervical discectomy and fusion · Spine surgery · GLP-1 · Glucagon-like peptide-1 receptor agonist · Obesity · Complications · Type-2 diabetes mellitus · Pseudarthrosis Dave Osinachukwu Duru[dd614@cam.ac.uk](dd614@cam.ac.uk) David Kwan Ryung Lee [dkrl2@cam.ac.uk](dkrl2@cam.ac.uk) Chloe Edmonds [ce419@cam.ac.uk](ce419@cam.ac.uk) Aron Abraham [Aa3123@ic.ac.uk](Aa3123@ic.ac.uk) Younis Peach [yp823@ic.ac.uk](yp823@ic.ac.uk) [Philip K. Louie](Philip K. Louie) [louie.philip@gmail.com](louie.philip@gmail.com) 1 School of Clinical Medicine, University of Cambridge, Cambridge, UK 2 Imperial College School of Medicine, London, UK 3 Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, USA Introduction Anterior cervical discectomy and fusion (ACDF) is an effective surgical treatment for degenerative cervical spine pathology refractory to non-operative management, with well-documented improvements in pain, function, and quality of life [2, 4, 21, 29, 30, 34] . ACDF is among the most commonly performed spinal procedures globally: over 150,000 are performed annually in the United States, with projections for continued growth through 2040, while in Finland the incidence rose more than 4-fold between 1999 and 2015 [18] . Similar increases in cervical spine surgery have been reported in Japan and China, driven by aging populations [17, 20] . As surgical volume has expanded, the prevalence of obesity and type 2 diabetes mellitus (T2DM) among ACDF candidates has risen in parallel; both conditions are associated with higher complication rates, though improved perioperative glycaemic control and weight optimisation can mitigate these ri

FAQs

What question did the systematic review address about GLP-1RA use and ACDF outcomes?

It assessed whether perioperative GLP-1RA use is associated with surgical outcomes following anterior cervical discectomy and fusion (ACDF).

How were studies selected and what search sources were used?

Studies were selected using PRISMA methodology with searches in MEDLINE, Embase, PubMed, and the Cochrane Library up to February 2026, focusing on human observational cohort studies.

What did the meta-analysis find regarding pseudarthrosis after ACDF?

GLP-1RA users had significantly lower odds of pseudarthrosis at 6, 12, and 24 months compared with non-users, while other complications showed inconsistent results across studies.

Oct 22, 2026

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