Cannabis Users Face Higher Opioid Use and Reoperation Rates After Spinal Fusion | Research

The takeaway

Cannabis users needed significantly more opioids in hospital, were 70% more likely to be readmitted, and nearly 4 times more likely to need reoperation after spinal fusion.

Spine surgeons, orthopedic surgeons, anesthesiologists, patients considering spinal fusion

What the researchers found

Meta-analysis of 7 studies (1,920 patients, 386 cannabis users) found significant increases in in-hospital opioid use (+58.84 MME), readmission (OR 1.70), and reoperation (OR 3.78) among cannabis users undergoing spinal fusion. No significant increase in surgical complications was observed.

Why it matters

Spinal fusion is one of the most common major surgeries, and cannabis use is increasingly prevalent among patients with chronic back pain. These findings suggest spine surgeons should screen for and counsel patients about cannabis use before surgery.

The numbers in context

7 studies, 1,920 patients (386 cannabis users). In-hospital opioid increase: +58.84 MME (95% CI 29.75-87.93). Readmission OR: 1.70 (95% CI 1.01-2.87). Reoperation OR: 3.78 (95% CI 2.06-6.94). No significant increase in surgical complications.

How the study worked

Systematic review and meta-analysis searching PubMed, Scopus, Web of Science, and Cochrane Library for studies comparing spinal fusion outcomes between preoperative cannabis users and non-users. Seven retrospective studies with 1,920 patients were included.

What this study cannot tell us

All 7 included studies were retrospective. Cannabis use was often self-reported and not standardized. Cannot account for confounding factors like chronic pain severity that might independently predict worse outcomes. Relatively small cannabis user group (386).

How to read the evidence

Systematic review with meta-analysis of 7 studies provides moderate evidence, limited by retrospective designs and potential confounding.

When this study was published

Published 2026 with comprehensive database search.

The bigger picture

The nearly 4-fold increase in reoperation risk is particularly alarming and suggests cannabis may affect not just acute pain management but also longer-term healing. This could change how spine surgeons approach preoperative cannabis cessation counseling.

Questions still open

What is the mechanism behind increased reoperation rates? Would preoperative cannabis cessation improve outcomes? Is there a dose-response relationship between cannabis use and surgical outcomes?

Common questions

Does cannabis use affect spinal surgery outcomes?

Yes — this meta-analysis found cannabis users needed significantly more opioids in hospital, were 70% more likely to be readmitted, and nearly 4 times more likely to need reoperation after spinal fusion surgery.

Should I stop using cannabis before spine surgery?

This research suggests cannabis use before spinal fusion is associated with worse outcomes, including higher opioid needs and reoperation rates. Discussing cannabis use with your surgeon before the procedure is strongly recommended.

Read the original research

Impact of Preoperative Cannabis use on Clinical Outcomes of Spinal Fusion - Systematic Review and Meta-analysis.

Spine

View on PubMed ↗Publisher’s paper ↗

Citation

Łajczak, Paweł; Łajczak, Anna; Pimenta, Newton Godoy. (2026). Impact of Preoperative Cannabis use on Clinical Outcomes of Spinal Fusion - Systematic Review and Meta-analysis.. Spine. https://doi.org/10.1097/BRS.0000000000005621