Semaglutide and improved spinal fusion outcomes: a correspondence

To the Editor,

I am writing to provide a commentary on the recent article titled “The impact of semaglutide on fusion rates following posterior lumbar fusion surgery in patients with type 2 diabetes” by Chang et al, published in the International Journal of Surgery[1]. As an endocrinologist with a particular interest in the metabolic effects of GLP-1 receptor agonists, I found this study both timely and relevant, given the increasing use of semaglutide in the management of type 2 diabetes and obesity.

The authors should be commended for addressing such an important clinical question as whether semaglutide affects spinal fusion outcomes in a well-designed retrospective analysis using a large multinational database. The use of propensity score matching to balance baseline characteristics between the semaglutide and non-semaglutide groups strengthens the validity of the observed associations. The significantly reduced risk of pseudarthrosis at 6 months, 1 year, and 2 years among semaglutide users is a noteworthy finding that may have meaningful clinical implications. This suggests that semaglutide could potentially confer benefits beyond glycemic control and cardiovascular risk reduction, possibly through effects on bone metabolism or systemic inflammation.

However, there are several aspects of the study that warrant further consideration. While the database is robust, the reliance on ICD-10 and CPT codes for outcome and exposure identification introduces the possibility of misclassification bias. Additionally, details regarding semaglutide dosing, duration of use, and adherence are not provided, which limits the ability to draw conclusions about dose-response relationships or optimal treatment duration. The study also does not account for other glucose-lowering medications or osteoporosis treatments that might influence bone healing. Furthermore, although the authors briefly mention a conflicting study by Khalid et al[2], which reported increased reoperation rates with semaglutide, more discussion on possible explanations for these discrepant findings would be valuable.

Moving forward, prospective studies incorporating radiographic confirmation of fusion, laboratory markers of bone turnover, and detailed medication histories would help clarify the mechanisms underlying these observations. It would also be beneficial to explore whether these findings extend to non-diabetic populations, particularly those with obesity undergoing spinal fusion.

In summary, this study makes a valuable contribution to the literature by highlighting a potential beneficial effect of semaglutide on spinal fusion outcomes in patients with type 2 diabetes. I encourage the authors to continue this line of research with more granular data and mechanistic insights to better inform clinical practice.

Ethical approval

Not applicable.

Consent

Not applicable.

Sources of funding

None.

Author contributions

Y.Q.: study concept or design, writing the paper; X.M.: supervision, writing – review & editing.

Conflicts of interest disclosure

The authors declare that they have no conflicts of interest.

Guarantor

Xin Mou.

Research registration unique identifying number (UIN)

Not applicable.

Provenance and peer review

Not applicable.

Data availability statement

Not applicable.

Declaration and use of AI

During the writing process, we did not use AI and followed the TITAN Guidelines 2025[3].