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High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion

De fortes doses d’anti-inflammatoires non stéroïdiens compromettent l’arthrodèse vertébrale

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Although nonsteroidal anti-inflammatory drugs (NSAIDs) provide benefit to patients following spinal fusion surgery, their routine administration has remained controversial due to concerns about possible deleterious effects on bone healing. The goal of this retrospective study was to assess the incidence of non-union following the perioperative administration of ketorolac, celecoxib, or rofecoxib.


We retrospectively analyzed the data of 434 patients receiving perioperative ketorolac (20–240 mg·day-1), celecoxib (200–600 mg·day-1), rofecoxib (50 mg·day-1), or no NSAIDs in the five days following spinal fusion surgery.


There were no significant differences in the incidence of non-union among the groups that received no NSAIDs (11/130; 8.5%), celecoxib 5/60; 8.3%), or rofecoxib (9/124; 7.3%). In contrast, 23/120 of patients (19.2%) that received ketorolac had a higher incidence (P < 0.001) of non-union compared to non-NSAID users. However, only 3/50 patients (6%) receiving low-dose ketorolac (≤110 mg·day-1) resulted in non-union which was not significantly different from non-NSAID users. Patients administered higher doses of ketorolac (120–240 mg·day-1) resulted in a higher incidence (P < 0.0001) of non-union (20/70; 29%) compared to non-NSAID users. For those patients developing non-union, there was a higher incidence comparing smokers vs non-smokers (P < 0.0001) and one level fusion vs two level fusions (P < 0.001).


This study revealed that the short-term perioperative administration of celecoxib, rofecoxib, or low-dose ketorolac (≤ 110 mg·day-1) had no significant deleterious effect on non-union. In contrast, higher doses of ketorolac (120–240 mg·day-1), history of smoking, and two level vertebral fusions resulted in a significant increase in the incidence of non-union following spinal fusion surgery.



Les anti-inflammatoires non stéroïdiens (AINS) sont bénéfiques après une arthrodèse vertébrale, mais leur administration régulière demeure controversée à cause des effets nuisibles possibles sur la cicatrisation de l’os. Notre étude rétrospective voulait évaluer l’incidence d’absence de fusion à la suite de l’administration périopératoire de kétorolac, célécoxib ou rofécoxib.


Nous avons procédé à l’analyse rétrospective de données sur 434 patients qui ont reçu du kétorolac (20–240 mg·jour-1), du célécoxib (200–600 mg·jour-1), du rofécoxib (50 mg·jour-1) ou aucun AINS dans les cinq jours suivant une arthrodèse vertébrale.


L’incidence d’absence de fusion osseuse n’était pas significativement différente entre les patients sans AINS (11/130 ; 8,5 %) et ceux qui ont eu du célécoxib 5/60 ; 8,3 %) ou du rofécoxib (9/124 ; 7,3 %). Par ailleurs, 23/120 des patients (19,2 %) qui ont reçu le kétorolac ont présenté une incidence plus élevée (P < 0,001) d’absence de fusion en comparaison de ceux qui ont pris des AINS. Seulement 3/50 patients (6 %) recevant de faibles doses de kétorolac (≤ 110 mg·jour-1) ont présenté une absence de fusion, ce qui n’est pas significativement différent des non-utilisateurs d’AINS. Des doses plus élevées de kétorolac (120–240 mg·jour-1), comparées aux non-AINS, ont provoqué une plus haute incidence (P < 0,0001) d’absence de fusion (20/70 ; 29 %). L’incidence d’absence de fusion était plus élevée si on compare les fumeurs vs les non-fumeurs (P < 0,0001) et la fusion à un niveau vs à deux niveaux (P < 0,001).


L’étude a révélé que l’administration périopératoire à court terme de célécoxib, de rofécoxib ou de faibles doses de kétorolac (≤ 110 mg·jour-1) n’a pas d’effet nuisible significatif sur l’absence de fusion. Par contre, des doses plus élevées de kétorolac (120–240 mg·jour-1), le tabagisme et des fusions vertébrales à deux niveaux augmentent significativement l’incidence d’absence de fusion à la suite d’une arthrodèse vertébrale.


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Correspondence to Scott S. Reuben or David Ablett or Rachel Kaye.

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Reuben, S.S., Ablett, D. & Kaye, R. High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion. Can J Anesth 52, 506–512 (2005). https://doi.org/10.1007/BF03016531

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  • Celecoxib
  • Rofecoxib
  • Ketorolac
  • Spinal Fusion
  • Level Fusion