Table 3.

The effect of NSAIDs on spinal fusion in humans.

Study/Year	Design	NSAID used	Conclusions and recommendations
Deguchi et al., 1998 [128]	Retrospective review of 73 patients undergoing primary or revision one or two level lumbar fusion	Not specified	(i) Patients who continued to take NSAIDs for more than 3 months postoperatively showed significantly lower fusion and success rates
Glassman et al., 1998 [129]	Retrospective review of 288 patients undergoing posterior L4 to sacral fusion	Ketorolac	(i) High rate of nonunion in spinal fusion (ii) Avoid NSAIDs in early postoperative period is recommended
Vitale et al., 2003 [130]	Retrospective review of 208 children undergoing scoliosis correction	Ketorolac	(i) No significantly increase in complications, including transfusion and reoperation
Park et al., 2005 [131]	Retrospective review of 88 consecutive patients undergoing posterolateral lumbar fusion	Ketorolac	(i) The incidence of incomplete union or nonunion was much higher in the ketorolac group, and the relative risk was approximately 6 times higher than control group
Pradhan et al., 2008 [132]	Retrospective review of 405 consecutive patients undergoing one, two or three level posterolateral lumbar fusion	Ketorolac	(i) The use of ketorolac limited to 48 hours after surgery for adjunctive analgesia, has no significant effect on ultimate fusion rates.
Sucato et al., 2008 [133]	Retrospective review of 319 patients undergoing scoliosis correction	Ketorolac	(i) Ketorolac does not increase the incidence of developing a pseudoarthrosis when used as an adjunct for postoperative analgesia
Lumawig et al., 2009 [134]	Retrospective review of 273 patients undergoing one or two level posterior lumbar fusion	Diclofenac	(i) Diclofenac sodium showed a dose-dependent inhibitory effect toward spinal fusion especially when used during the immediate postoperative period
Horn et al., 2010 [135]	Retrospective review of 46 pediatric patients who undergone spinal fusions for scoliosis	Ketorolac	(i) No clinical or radiographic evidence of curve progression, nonunion, or instrumentation failure