Abstract：
METHODS: This was a retrospective cohort study.
OBJECTIVE: To compare the rates of pseudarthrosis in patients undergoing 1 to 3 level transforaminal lumbar interbody fusion (TLIF) procedures between cannabis users and noncannabis users.
BACKGROUND: Recreational use of cannabis is common, though it remains poorly studied and legally ambiguous in the United States. Patients with back pain may turn to adjunctive use of cannabis to manage their pain. However, the implications of cannabis use on the achievement of bony fusion are not well-characterized.
METHODS: Patients who underwent 1 to 3 level TLIF for degenerative disc disease or degenerative spondylolisthesis between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Cannabis users were identified with ICD 10 code F12.90. Patients undergoing surgery for nondegenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with pseudarthrosis in a linear regression model. The primary outcome measure was development of pseudarthrosis within 24 months after 1 to 3 level TLIF. The secondary outcomes were the development of all-cause surgical complications as well as all-cause medical complications.
RESULTS: A 1:1 exact matching resulted in two equal groups of 1593 patients who did or did not use cannabis and underwent 1 to 3 level TLIF. Patients who used cannabis were 80% more likely to experience pseudarthrosis compared with patients who do not [relative risk (RR): 1.816, 95% CI: 1.291-2.556, P <0.001]. Similarly, cannabis use was associated with significantly higher rates of all-cause surgical complications (RR: 2.350, 95% CI: 1.399-3.947, P =0.001) and all-cause medical complications (RR: 1.934, 95% CI: 1.516-2.467, P <0.001).
CONCLUSIONS: After 1:1 exact matching to control for confounding variables, the findings of this study suggest that cannabis use is associated with higher rates of pseudarthrosis, as well as higher rates of all-cause surgical and all-cause medical complications. Further studies are needed to corroborate our findings.
OBJECTIVE: To compare the rates of pseudarthrosis in patients undergoing 1 to 3 level transforaminal lumbar interbody fusion (TLIF) procedures between cannabis users and noncannabis users.
BACKGROUND: Recreational use of cannabis is common, though it remains poorly studied and legally ambiguous in the United States. Patients with back pain may turn to adjunctive use of cannabis to manage their pain. However, the implications of cannabis use on the achievement of bony fusion are not well-characterized.
METHODS: Patients who underwent 1 to 3 level TLIF for degenerative disc disease or degenerative spondylolisthesis between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Cannabis users were identified with ICD 10 code F12.90. Patients undergoing surgery for nondegenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with pseudarthrosis in a linear regression model. The primary outcome measure was development of pseudarthrosis within 24 months after 1 to 3 level TLIF. The secondary outcomes were the development of all-cause surgical complications as well as all-cause medical complications.
RESULTS: A 1:1 exact matching resulted in two equal groups of 1593 patients who did or did not use cannabis and underwent 1 to 3 level TLIF. Patients who used cannabis were 80% more likely to experience pseudarthrosis compared with patients who do not [relative risk (RR): 1.816, 95% CI: 1.291-2.556, P <0.001]. Similarly, cannabis use was associated with significantly higher rates of all-cause surgical complications (RR: 2.350, 95% CI: 1.399-3.947, P =0.001) and all-cause medical complications (RR: 1.934, 95% CI: 1.516-2.467, P <0.001).
CONCLUSIONS: After 1:1 exact matching to control for confounding variables, the findings of this study suggest that cannabis use is associated with higher rates of pseudarthrosis, as well as higher rates of all-cause surgical and all-cause medical complications. Further studies are needed to corroborate our findings.
摘要：
方法：这是一项回顾性队列研究。
目的：比较大麻使用者和非大麻使用者接受1-3级经椎间孔腰椎椎间融合术（TLIF）患者的假关节发生率。
背景：娱乐使用大麻很常见，尽管它在美国仍然缺乏研究和法律上的模棱两可。背痛患者可能会转向辅助使用大麻来控制疼痛。然而,使用大麻对实现骨融合的影响没有得到很好的描述。
方法：使用PearlDiverMariner所有索赔保险数据库，在2010年至2022年期间因退行性椎间盘疾病或退行性腰椎滑脱而接受1至3级TLIF的患者。大麻用户被识别为ICD10代码F12.90。接受非变性病理如肿瘤手术的患者，创伤,或感染被排除。使用人口统计因素进行1：1精确匹配，医疗合并症,以及在线性回归模型中与假关节显着相关的手术因素。主要结果指标是在1至3级TLIF后24个月内发生假关节。次要结果是全因手术并发症和全因内科并发症的发展。
结果：A1:1精确匹配导致两组1593名患者使用或不使用大麻并接受1至3级TLIF。与未使用大麻的患者相比，使用大麻的患者发生假关节的可能性高80％[相对风险（RR）：1.816，95％CI：1.291-2.556，P<0.001]。同样，使用大麻与全因手术并发症(RR:2.350,95%CI:1.399-3.947,P=0.001)和全因医疗并发症(RR:1.934,95%CI:1.516-2.467,P<0.001)的发生率显著升高相关。
结论：在与混杂变量的对照1:1精确匹配后，这项研究的结果表明，使用大麻与更高的假关节发病率有关，以及全因手术和全因医疗并发症的发生率更高。需要进一步的研究来证实我们的发现。
目的：比较大麻使用者和非大麻使用者接受1-3级经椎间孔腰椎椎间融合术（TLIF）患者的假关节发生率。
背景：娱乐使用大麻很常见，尽管它在美国仍然缺乏研究和法律上的模棱两可。背痛患者可能会转向辅助使用大麻来控制疼痛。然而,使用大麻对实现骨融合的影响没有得到很好的描述。
方法：使用PearlDiverMariner所有索赔保险数据库，在2010年至2022年期间因退行性椎间盘疾病或退行性腰椎滑脱而接受1至3级TLIF的患者。大麻用户被识别为ICD10代码F12.90。接受非变性病理如肿瘤手术的患者，创伤,或感染被排除。使用人口统计因素进行1：1精确匹配，医疗合并症,以及在线性回归模型中与假关节显着相关的手术因素。主要结果指标是在1至3级TLIF后24个月内发生假关节。次要结果是全因手术并发症和全因内科并发症的发展。
结果：A1:1精确匹配导致两组1593名患者使用或不使用大麻并接受1至3级TLIF。与未使用大麻的患者相比，使用大麻的患者发生假关节的可能性高80％[相对风险（RR）：1.816，95％CI：1.291-2.556，P<0.001]。同样，使用大麻与全因手术并发症(RR:2.350,95%CI:1.399-3.947,P=0.001)和全因医疗并发症(RR:1.934,95%CI:1.516-2.467,P<0.001)的发生率显著升高相关。
结论：在与混杂变量的对照1:1精确匹配后，这项研究的结果表明，使用大麻与更高的假关节发病率有关，以及全因手术和全因医疗并发症的发生率更高。需要进一步的研究来证实我们的发现。
