The effect of ketorolac on thoracolumbar posterolateral fusion: a systematic review and meta-analysis

Ketorolac is a nonsteroidal anti-inflammatory drug often administered for pain control after spine surgery. The primary concern with ketorolac is the risk of pseudarthrosis following fusion. In this meta-analysis, the authors demonstrated that when ketorolac was administered or >2 days and at a dose of ≥120 mg/d, is associated with pseudarthrosis in adults after posterolateral lumbar fusion.

Ketorolac is a nonsteroidal anti-inflammatory drug provided to control pain following spine surgery. But, the major issue with ketorolac is the risk of pseudarthrosis after the fusion. This study aimed to assess the impact of postoperative ketorolac on pseudarthrosis after the thoracolumbar posterolateral spinal fusions.

Multiple medical reference databases were searched systematically for studies comprising postoperative use of Ketorolac among scoliosis surgery and lumbar fusion in pediatric patients and adults, respectively. As this analysis involved the assessment of heterogeneous patient populations going through specific approaches to fusion and different numbers of levels with variable means of diagnosis of pseudarthrosis, the random-effects model for heterogeneity used to conduct the meta-analysis. Pseudarthrosis was considered as the analysis outcome measures.  

A total of six studies comprising 1558 subjects were selected and out of all, 119 patients presented with pseudarthrosis. Pseudarthrosis was seen among adults with ketorolac given for >2 days and at doses ≥120 mg/d (OR, 4.75, 95% CI, 2.34–9.62; P<0.001) and adults with ketorolac given for >2 days, adults with doses of ≥120 mg/d (OR, 2.93, 95% CI, 1.06–8.12; P=0.039). The smokers with Ketorolac was found with pseudarthrosis.

The Ketorolac administration for >2 days and/or at a dose of ≥120 mg/d is correlated with pseudarthrosis among adults following posterolateral lumbar fusion.