Postoperative Ketorolac Administration and Pseudoarthrosis Following Multilevel Posterior Cervical Decompression and Fusion: A Retrospective Cohort Study.
Academic Article
Overview
abstract
INTRODUCTION: The effect of perioperative ketorolac use after posterior cervical decompression and fusion (PCDF) remains unclear with ongoing concern regarding NSAID-induced pseudoarthrosis. This study investigates the association between postoperative ketorolac use and pseudoarthrosis after multilevel PCDF. METHODS: This retrospective cohort study analyzed adults undergoing multilevel PCDF (2002-2024) using TriNetX. Patients were grouped by postoperative ketorolac within 48 hours versus acetaminophen only. Propensity matching controlled for demographics, comorbidities, and surgical indications. Primary outcome was pseudarthrosis at four years; further secondary outcomes were assessed at 30 days, 1 year, and 4 years. RESULTS: After matching, 1,376 patients were included in each cohort across 45 healthcare organizations. No significant differences were observed in pseudarthrosis (2.4% vs. 1.9%), reoperation (<10 instances), postoperative bleeding (0 instances), opioid prescription (13.8% vs. 13.5%), hardware complications (1.1% vs. 0.7%), pulmonary embolism (PE) (0 instances), deep vein thrombosis (DVT) (<10 instances), or surgical site infection (SSI) (<10 instances) at 30 days for the ketorolac group versus control. At 1-year no significant differences were seen in pseudarthrosis (6.3% vs. 6.3%), reoperation (1.7% vs. 2.0%), bleeding (0 instances), opioid use (35.6% vs. 34.8%), hardware issues (3.4% vs. 3.0%), PE (1.1% vs. 1.4%), DVT (1.4% vs. 2.1%), or SSI (1.1% vs. 0.8%). At 4 years, ketorolac use was linked to significantly reduced opioid prescriptions [RR 0.909; 95% CI (0.834, 0.980); P=0.0123], with no significant differences in pseudarthrosis (8.1% vs. 8.4%), reoperation (3.2% vs. 2.8%), bleeding (<10), hardware issues (5.2% vs. 4.7%), PE (1.7% vs. 1.7%), DVT (1.7% vs. 1.7%), or SSI (1.6% vs. 1.7%). CONCLUSION: Ketorolac administration following multilevel PCDF was not associated with increased rates of pseudarthrosis or other surgical complications at four years. Ketorolac use was linked to a modest reduction in oral opioid prescriptions. Ketorolac may be a safe and effective adjunct in postoperative analgesia.
