Time-dependent inhibitory effects of indomethacin on spinal fusion. Academic Article uri icon

Overview

abstract

  • BACKGROUND: The use of nonsteroidal anti-inflammatory drugs following spine arthrodesis is discouraged because of the negative effects on bone-healing. We are not aware of any data regarding when nonsteroidal anti-inflammatory drugs may be safely resumed postoperatively. We hypothesized that these drugs have a time-dependent deleterious effect on fusion, with the greatest inhibition during the early phases of fusion. METHODS: Seventy New Zealand White rabbits underwent posterior intertransverse process arthrodesis at L5-L6 with use of iliac autograft. Rabbits randomly received indomethacin (10 mg/kg orally) starting at two weeks after surgery (twenty-four animals), indomethacin starting at four weeks postoperatively (twenty-three), or saline starting at two weeks postoperatively (twenty-three) (the control group). The animals were killed at six weeks, and the spines were denuded of soft tissues and palpated for L5-L6 motion. Fusion was defined as the complete absence of motion. RESULTS: Sixty-five percent (fifteen) of the twenty-three spines in the control group and 48% (eleven) of the twenty-three in the four-week group fused. However, only 21% (five) of the twenty-four spines in the two-week group fused. The difference between the two-week and control groups was significant (p < 0.002), as was the difference between the two and four-week groups (p = 0.05). The difference between the four-week and control groups was not significant (p = 0.2). CONCLUSIONS: The earlier that indomethacin was resumed postoperatively, the greater was its negative effect on fusion. Indomethacin appears to play a significant inhibitory role in the early phase of healing. Initiating indomethacin treatment in the latter phase of healing does not appear to significantly affect fusion rates, although there was a nonsignificant trend toward inhibition. To our knowledge, this is the first investigation of the time-dependent nature of indomethacin's effect on bone-healing.

authors

  • Riew, Dan
  • Long, John
  • Rhee, John
  • Lewis, Stephen
  • Kuklo, Timothy
  • Kim, Yong Jung
  • Yukawa, Yasutsugu
  • Zhu, Yong

publication date

  • April 1, 2003

Research

keywords

  • Anti-Inflammatory Agents, Non-Steroidal
  • Bone Regeneration
  • Indomethacin
  • Spinal Fusion
  • Spine
  • Wound Healing

Identity

Scopus Document Identifier

  • 0038035692

Digital Object Identifier (DOI)

  • 10.2106/00004623-200304000-00007

PubMed ID

  • 12672837

Additional Document Info

volume

  • 85

issue

  • 4