Thiazide diuretic use is associated with fewer hardware complications after anterior cervical discectomy and fusion.

Purpose: To investigate the surgical outcomes and complications of ACDF among patients taking thiazide diuretics.

Methods: Cervical radiculopathy patients who underwent ACDF from 2010 to 2022 were retrospectively queried through the PearlDiver Database. Patients were included if they underwent ACDF with at least 2 years of follow-up and were on thiazide diuretics within 90 days of their procedure. A control group was created using propensity score matching based on age, gender, and Charlson Comorbidity Index. Univariate analysis using chi squared tests and student t-tests were used to compare demographics and outcomes between groups.

Results: A total of 16,886 cervical radiculopathy patients (8,443 used thiazide diuretics, 8,443 controls) treated with ACDF were identified through the database. The thiazide diuretic group had significantly lower rates of hardware complications compared to the control group (1.16% vs. 2.05%; P = 0.001). Pseudarthrosis rates were not significantly different between the thiazide diuretic group and the control group (3.98% vs. 3.60%; P = 0.371). Furthermore, rates of revision (11.8% vs. 10.5%; P = 0.07) and spondylolisthesis (3.90% vs. 3.60%; P = 0.482) after ACDF were not significantly different.

Conclusion: This large retrospective database study over 12 years found that lower rates of hardware complications were seen in cervical radiculopathy patients who were prescribed thiazide diuretics after ACDF surgery. However, these patients may still be at a similar risk for other postoperative surgical complications, including pseudoarthrosis, revision surgery, and spondylolisthesis.