The Impact of Non-Steroidal Anti-inflammatory Drugs on Postoperative Outcomes in Posterior Spinal Surgery: A Systematic Review.

Abstract

Study DesignSystematic Review.ObjectiveTo review the effect of NSAID administration on postoperative outcomes following posterior spinal surgery, with specific attention to pain control, opioid reduction, bleeding risk, and fusion outcomes.MethodsPubMed, Google Scholar, Cochrane Library, Embase, Scopus, and Web of Science were queried through September 2025. Studies were included if they included adult patients undergoing posterior spinal procedures, including both fusion and non-fusion surgeries. In addition, studies had to report perioperative NSAID use in posterior spinal surgery with relevant clinical outcomes: Postoperative pain, opioid consumption, blood loss, wound complications, nonunion, and hardware failure. Bias was assessed with MINORS and Newcastle-Ottawa Scales.ResultsEleven studies (396,206 patients) were included. Across posterior fusion and non-fusion procedures, short-term NSAID use consistently reduced postoperative opioid consumption and improved early pain control, with no clinically meaningful increase in bleeding or wound complications. However, prolonged NSAID use was associated with increased risks of nonunion, hardware failure, and wound complications in fusion cohorts. Significant variability in NSAID type, dose, timing, and study design exists.ConclusionsShort-term NSAID use appears safe and effective as an opioid-sparing strategy in non-fusion posterior spinal surgery. Prolonged or high-dose administration may compromise fusion outcomes. Future high-quality studies are needed to definitively define the optimal postoperative NSAID window, dosing, and administration route.