Cannabis use disorder was linked to more complications after spine fusion surgery but also less opioid dependence | Research

The takeaway

Spine fusion patients with cannabis use disorder had higher rates of neurological, wound, and cardiac complications but also showed decreased opioid dependence after surgery.

Spine surgeons and anesthesiologists managing perioperative care; pain management specialists working with cannabis-using patients.

More surgical complications but less opioid dependence with CUD

What the researchers found

Among 72,024 cervical and 105,612 lumbar fusion patients, those with CUD (2% and 1.5% respectively) had higher complication rates including neurological complications, wound complications, and cardiac events at various time points. CUD was associated with increased stroke risk in cervical fusions and cardiac/MI complications in lumbar fusions. However, CUD was also associated with decreased opioid dependence postoperatively. No differences in reoperation rates were observed.

Why it matters

With growing cannabis use, spine surgeons need to know how CUD affects surgical outcomes. The dual finding of more complications but less opioid dependence creates a complex risk-benefit picture for perioperative management.

The numbers in context

72,024 cervical (2.0% CUD) and 105,612 lumbar (1.5% CUD) fusion patients. Cervical CUD: neurological complications 3% vs 2%, wound complications 5% vs 3% at 12 months. Lumbar CUD: wound 8% vs 5%, MI 2% vs 1% at 6 months. Decreased postoperative opioid dependence with CUD.

How the study worked

Retrospective cohort using IBM MarketScan Database (2009-2019). Exact match hospitalization analysis with outcomes at index hospitalization, 6 months, and 12 months. Patients with and without CUD were compared.

What this study cannot tell us

Administrative database cannot control for confounding by other substance use or socioeconomic factors. CUD patients were younger males with higher comorbidity burden. CUD diagnosis codes undercount cannabis use. Cannot determine dose, frequency, or timing of use.

How to read the evidence

Large database study with 10 years of data, but retrospective design and administrative coding limit causal claims.

When this study was published

2024 study

The bigger picture

The paradox of more surgical complications but less opioid dependence suggests cannabis users may have different pain management trajectories. Surgeons may need to monitor for specific complications while potentially leveraging the reduced opioid risk.

Questions still open

Is the reduced opioid dependence because cannabis users substitute cannabis for opioids postoperatively? Do the complications reflect CUD itself or correlated lifestyle factors?

Common questions

Should people stop cannabis before spine surgery?

The study does not answer this directly. It found associations between CUD diagnosis and outcomes but could not determine whether stopping cannabis before surgery would change the complication rates.

Why were cardiac complications higher?

Cannabis has known cardiovascular effects including transient changes in heart rate and blood pressure. Combined with surgical stress, these may increase cardiac risk, though the exact mechanism is not established by this study.

Read the original research

Cannabis Use Disorder Trends and Health Care Utilization After Cervical and Lumbar Spine Fusions.

Spine, 49(4), E28-E45

View on PubMed ↗Publisher’s paper ↗

Citation

Dietz, Nicholas; Alkin, Victoria; Agarwal, Nitin; Sharma, Mayur; Oxford, Brent Garrison; Wang, Dengzhi; Ugiliweneza, Beatrice; Mettille, Jersey; Boakye, Maxwell; Drazin, Doniel. (2024). Cannabis Use Disorder Trends and Health Care Utilization After Cervical and Lumbar Spine Fusions.. Spine, 49(4), E28-E45. https://doi.org/10.1097/BRS.0000000000004874