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Ketorolac and Spinal Fusion: Does the Perioperative Use of Ketorolac Really Inhibit Spinal Fusion?

Pradhan, Ben B., MD, MSE*; Tatsumi, Robert L., MD; Gallina, Jason, MD; Kuhns, Craig A., MD§; Wang, Jeffrey C., MD; Dawson, Edgar G., MD

doi: 10.1097/BRS.0b013e31818396f4
Clinical Case Series

Study Design. Retrospective review.

Objective. To evaluate the effect of postoperative use of ketorolac (Toradol) on spinal fusion in humans.

Summary of Background Data. The value of parenteral ketorolac in postoperative analgesia has been well documented across surgical specialties. However, some studies have shown that ketorolac may adversely affect osteogenic activity and fracture healing.

Methods. A total of 405 consecutive patients who underwent primary lumbar posterolateral intertransverse process fusion with pedicle screw instrumentation were included in this retrospective study. A subtotal of 228 patients received Toradol after surgery for adjunctive analgesia. Each patient received a mandatory dose of 30 mg intravenously every 6 hours for 48 hours. The same surgeon performed the fusion procedure on all of these patients. Historical controls included 177 patients who did not receive Toradol after surgery. The minimum follow-up period was 24 months. Nonunions were diagnosed by analyzing sequential radiographs, flexion-extension radiographs, and computed tomography with multiplanar reconstructions. The gold standard of surgical exploration was performed in symptomatic patients with diagnostic ambiguity or nonunions diagnosed by imaging.

Results. There were no smokers in the study population. Pseudarthrosis was identified in 12 of 228 patients (5.3%) who received Toradol after surgery, and in 11 of 177 patients (6.2%) who did not. There was no significant difference detected in the nonunion rates between the two groups (P > 0.05, χ2 method).

Conclusion. Use of ketorolac after spinal fusion surgery in humans, limited to 48 hours after surgery for adjunctive analgesia, has no significant effect on ultimate fusion rates.

Four hundred five underwent primary lumbar fusion with pedicle screw instrumentation spanning 1–3 levels. About 208 patients received Toradol (30 mg intravenously every 6 hours for 48 hours) after surgery for adjunctive analgesia. Compared with the 107 patients who did not receive Toradol after surgery, there was no significant effect on ultimate fusion rates.

From the *Risser Orthopaedic Group, Pasadena, CA; the †Pacific Spine Specialists, Tualatin, OR; ‡New York, NY; the §University of Missouri School of Medicine, Columbia, MO; ¶UCLA School of Medicine, Los Angeles, CA. ∥Edgar G. Dawson, MD, is deceased.

Acknowledgment date: November 25, 2007. Acceptance date: February 28, 2008.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Ben B. Pradhan, MD, MSE, Risser Orthopaedic Group, 2627 East Washington Boulevard, Pasadena, CA 91107; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.