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European Spine Journal

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10.03.2017 | Review Article

The effect of NSAIDs on spinal fusion: a cross-disciplinary review of biochemical, animal, and human studies

verfasst von: Ahilan Sivaganesan, Silky Chotai, Gabrielle White-Dzuro, Matthew J. McGirt, Clinton J. Devin

Erschienen in: European Spine Journal | Ausgabe 11/2017

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Abstract

Purpose

Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in postoperative pain management. However, their use in the setting of spine fusion surgery setting has long been a topic of controversy. In this review we examined relevant research, including in vivo, animal, and clinical human studies, with the aim of understanding the effect of NSAIDs on spinal fusion.

Study design/setting

Systematic review of study designs of all types from randomized controlled trials and meta-analyses to single-institution retrospective reviews.

Methods

A search of PubMed and Embase was conducted using the keywords: “spine,” “spinal fracture,” NSAIDs, anti-inflammatory non-steroidal agents, bone, bone healing, fracture, fracture healing, yielding a total of 110 studies. Other 28 studies were identified by cross-referencing, resulting in total 138 studies.

Results

There is no level I evidence from human studies regarding the use of NSAIDs on spinal fusion rates. The overall tone of the spine literature in the early 2000s was that NSAIDs increased the rate of non-union; however, nearly all human studies published after 2005 suggest that short-term (<2 weeks) postoperative use have no such effect. The dose dependency that is seen with a 2-week postoperative course is not present when NSAIDs are only used for 48 h after surgery.

Conclusions

NSAID appear to have dose-dependent and duration-dependent effects on fusion rates. The short-term use of low-dose NSAIDs around the time of spinal fusion surgery is reasonable. Spine surgeons can consider the incorporation of NSAIDs into pain control regimens for spinal fusion patients with the goal of improving pain control and reducing the costs and complications associated with opioids.

Convery PN, Milligan KR, Quinn P, Scott K, Clarke RC (1998) Low-dose intra-articular ketorolac for pain relief following arthroscopy of the knee joint. Anaesthesia 53:1125–1129CrossRefPubMed

Dahl JB, Kehlet H (1991) Non-steroidal anti-inflammatory drugs: rationale for use in severe postoperative pain. Br J Anaesth 66:703–712CrossRefPubMed

McCormack K (1994) The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs 47(suppl 5):28–45 (discussion 46–27) CrossRefPubMed

Reuben SS, Steinberg RB, Kreitzer JM, Duprat KM (1995) Intravenous regional anesthesia using lidocaine and ketorolac. Anesth Analg 81:110–113PubMed

Souter AJ, Fredman B, White PF (1994) Controversies in the perioperative use of nonsterodial antiinflammatory drugs. Anesth Analg 79:1178–1190CrossRefPubMed

Jirarattanaphochai K, Jung S (2008) Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials. J Neurosurg Spine 9:22–31. doi:10.3171/spi/2008/9/7/022 CrossRefPubMed

Yamashita K, Fukusaki M, Ando Y, Fujinaga A, Tanabe T, Terao Y, Sumikawa K (2006) Preoperative administration of intravenous flurbiprofen axetil reduces postoperative pain for spinal fusion surgery. J Anesthesia 20:92–95. doi:10.1007/s00540-006-0389-6 CrossRef

Yukawa Y, Kato F, Ito K, Terashima T, Horie Y (2005) A prospective randomized study of preemptive analgesia for postoperative pain in the patients undergoing posterior lumbar interbody fusion: continuous subcutaneous morphine, continuous epidural morphine, and diclofenac sodium. Spine 30:2357–2361CrossRefPubMed

Reuben SS, Ekman EF (2005) The effect of cyclooxygenase-2 inhibition on analgesia and spinal fusion. J Bone Jt Surg Am 87:536–542. doi:10.2106/jbjs.d.02283 CrossRef

10.

Aubrun F, Langeron O, Heitz D, Coriat P, Riou B (2000) Randomised, placebo-controlled study of the postoperative analgesic effects of ketoprofen after spinal fusion surgery. Acta Anaesthesiol Scand 44:934–939CrossRefPubMed

11.

Jevsevar DS, Brown GA, Jones DL, Matzkin EG, Manner PA, Mooar P, Schousboe JT, Stovitz S, Sanders JO, Bozic KJ, Goldberg MJ, Martin WR 3rd, Cummins DS, Donnelly P, Woznica A, Gross L (2013) The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition. J Bone Jt Surg Am 95:1885–1886CrossRef

12.

Pountos I, Giannoudis PV, Jones E, English A, Churchman S, Field S, Ponchel F, Bird H, Emery P, McGonagle D (2011) NSAIDS inhibit in vitro MSC chondrogenesis but not osteogenesis: implications for mechanism of bone formation inhibition in man. J Cell Mol Med 15:525–534. doi:10.1111/j.1582-4934.2010.01006.x CrossRefPubMed

13.

Dumont AS, Verma S, Dumont RJ, Hurlbert RJ (2000) Nonsteroidal anti-inflammatory drugs and bone metabolism in spinal fusion surgery: a pharmacological quandary. J Pharmacol Toxicol Methods 43:31–39CrossRefPubMed

14.

Dimar JR 2nd, Ante WA, Zhang YP, Glassman SD (1996) The effects of nonsteroidal anti-inflammatory drugs on posterior spinal fusions in the rat. Spine 21:1870–1876CrossRefPubMed

15.

Martin GJ Jr, Boden SD, Titus L (1999) Recombinant human bone morphogenetic protein-2 overcomes the inhibitory effect of ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), on posterolateral lumbar intertransverse process spine fusion. Spine 24:2188–2193 (discussion 2193–2184) CrossRefPubMed

16.

Riew KD, Long J, Rhee J, Lewis S, Kuklo T, Kim YJ, Yukawa Y, Zhu Y (2003) Time-dependent inhibitory effects of indomethacin on spinal fusion. J Bone Jt Surg Am 85(4):632–634CrossRef

17.

Dahners LE, Mullis BH (2004) Effects of nonsteroidal anti-inflammatory drugs on bone formation and soft-tissue healing. J Am Acad Orthop Surg 12:139–143CrossRefPubMed

18.

Urrutia J, Mardones R, Quezada F (2007) The effect of ketoprophen on lumbar spinal fusion healing in a rabbit model. Laboratory investigation. J Neurosurg Spine 7:631–636. doi:10.3171/spi-07/12/631 CrossRefPubMed

19.

Long J, Lewis S, Kuklo T, Zhu Y, Riew KD (2002) The effect of cyclooxygenase-2 inhibitors on spinal fusion. J Bone Jt Surg Am 84(10):1763–1768CrossRef

20.

Glassman SD, Rose SM, Dimar JR, Puno RM, Campbell MJ, Johnson JR (1998) The effect of postoperative nonsteroidal anti-inflammatory drug administration on spinal fusion. Spine 23:834–838CrossRefPubMed

21.

Lumawig JM, Yamazaki A, Watanabe K (2009) Dose-dependent inhibition of diclofenac sodium on posterior lumbar interbody fusion rates. Spine J 9:343–349. doi:10.1016/j.spinee.2008.06.455 CrossRefPubMed

22.

Deguchi M, Rapoff AJ, Zdeblick TA (1998) Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord 11:459–464CrossRefPubMed

23.

Park SY, Moon SH, Park MS, Oh KS, Lee HM (2005) The effects of ketorolac injected via patient controlled analgesia postoperatively on spinal fusion. Yonsei Med J 46:245–251CrossRefPubMedPubMedCentral

24.

Reuben SS, Ablett D, Kaye R (2005) High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion. Can J Anaesth 52:506–512. doi:10.1007/bf03016531 CrossRefPubMed

25.

Pradhan BB, Tatsumi RL, Gallina J, Kuhns CA, Wang JC, Dawson EG (2008) Ketorolac and spinal fusion: does the perioperative use of ketorolac really inhibit spinal fusion? Spine 33:2079–2082. doi:10.1097/BRS.0b013e31818396f4 CrossRefPubMed

26.

Sucato DJ, Lovejoy JF, Agrawal S, Elerson E, Nelson T, McClung A (2008) Postoperative ketorolac does not predispose to pseudoarthrosis following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Spine 33:1119–1124. doi:10.1097/BRS.0b013e31816f6a2a CrossRefPubMed

27.

Dodwell ER, Latorre JG, Parisini E, Zwettler E, Chandra D, Mulpuri K, Snyder B (2010) NSAID exposure and risk of nonunion: a meta-analysis of case-control and cohort studies. Calcif Tissue Int 87:193–202. doi:10.1007/s00223-010-9379-7 CrossRefPubMed

28.

Li Q, Zhang Z, Cai Z (2011) High-dose ketorolac affects adult spinal fusion: a meta-analysis of the effect of perioperative nonsteroidal anti-inflammatory drugs on spinal fusion. Spine 36:E461–E468. doi:10.1097/BRS.0b013e3181dfd163 CrossRefPubMed

29.

Blomquist J, Solheim E, Liavaag S, Baste V, Havelin LI (2014) Do nonsteroidal anti-inflammatory drugs affect the outcome of arthroscopic Bankart repair? Scand J Med Sci Sports 24:e510–e514. doi:10.1111/sms.12233 CrossRefPubMedPubMedCentral

30.

Cappello T, Nuelle JA, Katsantonis N, Nauer RK, Lauing KL, Jagodzinski JE, Callaci JJ (2013) Ketorolac administration does not delay early fracture healing in a juvenile rat model: a pilot study. J Pediatr Orthop 33:415–421. doi:10.1097/BPO.0b013e318288b46f CrossRefPubMedPubMedCentral

31.

Chikazu D, Fujikawa Y, Fujihara H, Suenaga H, Saijo H, Ohkubo K, Ogasawara T, Mori Y, Iino M, Takato T (2011) Cyclooxygenase-2 activity is important in craniofacial fracture repair. Int J Oral Maxillofac Surg 40:322–326. doi:10.1016/j.ijom.2010.10.011 CrossRefPubMed

32.

Fracon RN, Teofilo JM, Satin RB, Lamano T (2008) Prostaglandins and bone: potential risks and benefits related to the use of nonsteroidal anti-inflammatory drugs in clinical dentistry. J Oral Sci 50:247–252CrossRefPubMed

33.

Jones P, Lamdin R (2010) Oral cyclo-oxygenase 2 inhibitors versus other oral analgesics for acute soft tissue injury: systematic review and meta-analysis. Clin Drug Investig 30:419–437. doi:10.2165/11533350-000000000-00000 CrossRefPubMed

34.

Sakka S, Hanouneh SI (2013) Investigation of the effect of ibuprofen on the healing of osseointegrated oral implants. J Investig Clin Dent 4:113–119. doi:10.1111/j.2041-1626.2012.00164.x CrossRefPubMed

35.

Salari P, Abdollahi M (2009) Controversial effects of non-steroidal anti-inflammatory drugs on bone: a review. Inflamm Allergy Drug Targets 8:169–175CrossRefPubMed

36.

Seidenberg AB, An YH (2004) Is there an inhibitory effect of COX-2 inhibitors on bone healing? Pharmacol Res 50:151–156. doi:10.1016/j.phrs.2003.12.017 CrossRefPubMed

37.

Teofilo JM, Giovanini GS, Fracon RN, Lamano T (2011) Histometric study of alveolar bone healing in rats treated with the nonsteroidal anti-inflammatory drug nimesulide. Implant Dent 20:e7–e13. doi:10.1097/ID.0b013e31820fbacf CrossRefPubMed

38.

Utvag SE, Fuskevag OM, Shegarfi H, Reikeras O (2010) Short-term treatment with COX-2 inhibitors does not impair fracture healing. J Investig Surg 23:257–261. doi:10.3109/08941939.2010.481009 CrossRef

39.

Eck JC, Gomez BA, Yaszemski MJ (2009) The effects of postoperative ketorolac on wound healing in a rat model. Orthopedics 32:827. doi:10.3928/01477447-20090922-04 PubMed

40.

Moreschi E, Biguetti CC, Comparim E, De Andrade Holgado L, Ribeiro-Junior PD, Nary-Filho H, Matsumoto MA (2013) Cyclooxygenase-2 inhibition does not impair block bone grafts healing in rabbit model. J Mol Histol 44:723–731. doi:10.1007/s10735-013-9519-2 CrossRefPubMed

41.

Nyangoga H, Aguado E, Goyenvalle E, Basle MF, Chappard D (2010) A non-steroidal anti-inflammatory drug (ketoprofen) does not delay beta-TCP bone graft healing. Acta Biomater 6:3310–3317. doi:10.1016/j.actbio.2010.01.042 CrossRefPubMed

42.

Pountos I, Georgouli T, Calori GM, Giannoudis PV (2012) Do nonsteroidal anti-inflammatory drugs affect bone healing? A critical analysis. Sci World J 2012:606404. doi:10.1100/2012/606404 CrossRef

43.

Geusens P, Emans PJ, de Jong JJ, van den Bergh J (2013) NSAIDs and fracture healing. Curr Opin Rheumatol 25:524–531. doi:10.1097/BOR.0b013e32836200b8 CrossRefPubMed

44.

Kurmis AP, Kurmis TP, O’Brien JX, Dalen T (2012) The effect of nonsteroidal anti-inflammatory drug administration on acute phase fracture-healing: a review. J Bone Jt Surg Am 94:815–823. doi:10.2106/jbjs.j.01743 CrossRef

45.

Janum S, Kristensen BB (2012) No evidence of malicious effect of NSAID treatment on bone healing. Ugeskr Laeger 174:3007–3010PubMed

46.

Simon AM, O’Connor JP (2007) Dose and time-dependent effects of cyclooxygenase-2 inhibition on fracture-healing. J Bone Jt Surg Am 89:500–511. doi:10.2106/jbjs.f.00127

47.

Fracon RN, Teofilo JM, Moris IC, Lamano T (2010) Treatment with paracetamol, ketorolac or etoricoxib did not hinder alveolar bone healing: a histometric study in rats. J Appl Oral Sci 18:630–634CrossRefPubMedPubMedCentral

48.

Fu JH, Bashutski JD, Al-Hezaimi K, Wang HL (2012) Statins, glucocorticoids, and nonsteroidal anti-inflammatory drugs: their influence on implant healing. Implant Dent 21:362–367. doi:10.1097/ID.0b013e3182611ff6 CrossRefPubMed

49.

Gomes FI, Aragao MG, Pinto VD, Gondim DV, Barbosa FC, Silva AA, Bezerra MM, Chaves HV (2013) Effects of nonsteroidal antiinflammatory drugs on osseointegration: a review. J Oral Implantol. doi:10.1563/aaid-joi-d-13-00125.1

50.

Thaller J, Walker M, Kline AJ, Anderson DG (2005) The effect of nonsteroidal anti-inflammatory agents on spinal fusion. Orthopedics 28:299–303 (quiz 304–295) PubMed

51.

Vuolteenaho K, Moilanen T, Moilanen E (2008) Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol 102:10–14. doi:10.1111/j.1742-7843.2007.00149.x PubMed

52.

Harder AT, An YH (2003) The mechanisms of the inhibitory effects of nonsteroidal anti-inflammatory drugs on bone healing: a concise review. J Clin Pharmacol 43:807–815CrossRefPubMed

53.

Gaston MS, Simpson AH (2007) Inhibition of fracture healing. J Bone Jt Surg Br 89:1553–1560. doi:10.1302/0301-620x.89b12.19671 CrossRef

54.

Boursinos LA, Karachalios T, Poultsides L, Malizos KN (2009) Do steroids, conventional non-steroidal anti-inflammatory drugs and selective Cox-2 inhibitors adversely affect fracture healing? J Musculoskelet Neuronal Interact 9:44–52PubMed

55.

van Esch RW, Kool MM, van As S (2013) NSAIDs can have adverse effects on bone healing. Med Hypotheses 81:343–346. doi:10.1016/j.mehy.2013.03.042 CrossRefPubMed

56.

Gajraj NM (2003) The effect of cyclooxygenase-2 inhibitors on bone healing. Reg Anesth Pain Med 28:456–465CrossRefPubMed

57.

Marquez-Lara A, Hutchinson ID, Nunez F Jr, Smith TL, Miller AN (2016) Nonsteroidal anti-inflammatory drugs and bone-healing: a systematic review of research quality. JBJS Rev. doi:10.2106/jbjs.rvw.o.00055 PubMed

58.

Cottrell J, O’Connor JP (2010) Effect of non-steroidal anti-inflammatory drugs on bone healing. Pharmaceuticals (Basel, Switzerland) 3:1668–1693. doi:10.3390/ph3051668 CrossRef

59.

Konstantinidis I, Papageorgiou SN, Kyrgidis A, Tzellos TG, Kouvelas D (2013) Effect of non-steroidal anti-inflammatory drugs on bone turnover: an evidence-based review. Rev Recent Clin Trials 8:48–60CrossRefPubMed

60.

Chang WK, Wu HL, Yang CS, Chang KY, Liu CL, Chan KH, Sung CS (2013) Effect on pain relief and inflammatory response following addition of tenoxicam to intravenous patient-controlled morphine analgesia: a double-blind, randomized, controlled study in patients undergoing spine fusion surgery. Pain Med (Malden Mass) 14:736–748. doi:10.1111/pme.12067 CrossRef

61.

Gerstenfeld LC, Thiede M, Seibert K, Mielke C, Phippard D, Svagr B, Cullinane D, Einhorn TA (2003) Differential inhibition of fracture healing by non-selective and cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs. J Orthop Res 21:670–675. doi:10.1016/s0736-0266(03)00003-2 CrossRefPubMed

62.

Lebwohl NH, Starr JK, Milne EL, Latta LL, TI M (1994) Inhibitory effect of ibuprofen on spinal fusion in rabbits. In: American Academy of Orthopaedic Surgeons American Academy of Orthopaedic Surgeons Rosemont, IL, p 278

63.

Vitale MG, Choe JC, Hwang MW, Bauer RM, Hyman JE, Lee FY, Roye DP Jr (2003) Use of ketorolac tromethamine in children undergoing scoliosis surgery. an analysis of complications. Spine J 3:55–62CrossRefPubMed

64.

Kidd LJ, Cowling NR, Wu AC, Kelly WL, Forwood MR (2013) Selective and non-selective cyclooxygenase inhibitors delay stress fracture healing in the rat ulna. J Orthop Res 31:235–242. doi:10.1002/jor.22203 CrossRefPubMed

65.

Lack WD, Fredericks D, Petersen E, Donovan M, George M, Nepola J, Smucker J, Femino JE (2013) Effect of aspirin on bone healing in a rabbit ulnar osteotomy model. J Bone Jt Surg Am 95:488–496. doi:10.2106/jbjs.l.00462 CrossRef

66.

Lu C, Xing Z, Wang X, Mao J, Marcucio RS, Miclau T (2012) Anti-inflammatory treatment increases angiogenesis during early fracture healing. Arch Orthop Trauma Surg 132:1205–1213. doi:10.1007/s00402-012-1525-4 CrossRefPubMed

67.

Hak DJ, Schulz KS, Khoie B, Hazelwood SJ (2011) The effect of Cox-2 specific inhibition on direct fracture healing in the rabbit tibia. J Orthop Sci 16:93–98. doi:10.1007/s00776-010-0016-0 CrossRefPubMed

68.

Dimmen S, Nordsletten L, Madsen JE (2009) Parecoxib and indomethacin delay early fracture healing: a study in rats. Clin Orthop Relat Res 467:1992–1999. doi:10.1007/s11999-009-0783-0 CrossRefPubMedPubMedCentral

69.

Inal S, Kabay S, Cayci MK, Kuru HI, Altikat S, Akkas G, Deger A (2014) Comparison of the effects of dexketoprofen trometamol, meloxicam and diclofenac sodium on fibular fracture healing, kidney and liver: an experimental rat model. Injury 45:494–500. doi:10.1016/j.injury.2013.10.002 CrossRefPubMed

70.

Jeffcoach DR, Sams VG, Lawson CM, Enderson BL, Smith ST, Kline H, Barlow PB, Wylie DR, Krumenacker LA, McMillen JC, Pyda J, Daley BJ (2014) Nonsteroidal anti-inflammatory drugs’ impact on nonunion and infection rates in long-bone fractures. J Trauma Acute Care Surg 76:779–783. doi:10.1097/TA.0b013e3182aafe0d CrossRefPubMed

71.

Bhattacharyya T, Levin R, Vrahas MS, Solomon DH (2005) Nonsteroidal antiinflammatory drugs and nonunion of humeral shaft fractures. Arthritis Rheum 53:364–367. doi:10.1002/art.21170 CrossRefPubMed

72.

Giannoudis PV, MacDonald DA, Matthews SJ, Smith RM, Furlong AJ, De Boer P (2000) Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Jt Surg Br 82:655–658CrossRef

73.

Burd TA, Hughes MS, Anglen JO (2003) Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone nonunion. J Bone Jt Surg Br 85:700–705

74.

Alissa R, Sakka S, Oliver R, Horner K, Esposito M, Worthington HV, Coulthard P (2009) Influence of ibuprofen on bone healing around dental implants: a randomised double-blind placebo-controlled clinical study. Eur J Oral Implantol 2:185–199PubMed

75.

Sagi HC, Jordan CJ, Barei DP, Serrano-Riera R, Steverson B (2014) Indomethacin prophylaxis for heterotopic ossification after acetabular fracture surgery increases the risk for nonunion of the posterior wall. J Orthop Trauma 28:377–383. doi:10.1097/bot.0000000000000049 CrossRefPubMed

76.

Adolphson P, Abbaszadegan H, Jonsson U, Dalen N, Sjoberg HE, Kalen S (1993) No effects of piroxicam on osteopenia and recovery after Colles’ fracture. A randomized, double-blind, placebo-controlled, prospective trial. Arch Orthop Trauma Surg 112:127–130CrossRefPubMed

77.

Davis T, Ackroyd C (1988) Non-steroidal anti-inflammatory agents in the management of Colles’ fractures. Br J Clin Pract 42:184–189PubMed

78.

Winnett B, Tenenbaum HC, Ganss B, Jokstad A (2016) Perioperative use of non-steroidal anti-inflammatory drugs might impair dental implant osseointegration. Clin Oral Implant Res 27:e1–e7. doi:10.1111/clr.12493 CrossRef

79.

DePeter KC, Blumberg SM, Dienstag Becker S, Meltzer JA (2016) Does the use of Ibuprofen in children with extremity fractures increase their risk for bone healing complications? J Emerg Med. doi:10.1016/j.jemermed.2016.09.027 PubMed

Titel: The effect of NSAIDs on spinal fusion: a cross-disciplinary review of biochemical, animal, and human studies
verfasst von: Ahilan Sivaganesan
Silky Chotai
Gabrielle White-Dzuro
Matthew J. McGirt
Clinton J. Devin
Publikationsdatum: 10.03.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 11/2017
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5021-y

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