Further Evidence against NSAID Use
Nonsteroidal anti-inflammatory drugs (NSAIDs), which are commonly prescribed to manage a variety of conditions, can have dangerous side effects, including stomach ulceration and bleeding, kidney dysfunction, and increased trigger points.
The influence of intramuscular injections of a specific NSAID, Keterolac, on postoperative spinal fusion patients was studied by examining hospital records.
The medical records of 288 patients who underwent instrumented spinal fusion from L4 to the sacrum over a two-year period were reviewed. The 121 patients who received no nonsteroidal anti-inflammatory drugs were compared with the 167 patients who received ketorolac after surgery. Ketorolac had a significant adverse effect on fusion, with 29 nonunions in the ketorolac group vs. five nonunions in the nondrug group. Ketorolac also decreased the fusion rate for subgroups, including men, women, smokers and nonsmokers. Overall, nonunion was approximately five times more likely after ketorolac administration.
Keterolac significantly inhibited spinal fusion at doses typically used for postoperative pain control. The study authors recommend that the administration of NSAIDs be avoided in the early postoperative period, and lend further support to recommendations to more effectively research this commonly used classification of drugs.
This provocative study, and the excellent commentary following it, provide stimulating discussion and deserve complete and thorough reading.
Glassman SD, Rose SM, et al. The effect of postoperative nonsteroidal anti-inflammatory drug administration on spinal fusion. Spine, April 1998;23(7), pp834-38.