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Investigating the Relationship Between High Density Lipoprotein Cholesterol and Fusion Outcomes Following Single Level Lumbar Fusion: A Propensity Matched Analysis
Journal article   Open access   Peer reviewed

Investigating the Relationship Between High Density Lipoprotein Cholesterol and Fusion Outcomes Following Single Level Lumbar Fusion: A Propensity Matched Analysis

Kyle Stump, William Han, Henry Morar, Kayla Lee, Stephan Aynaszyan, Dhara Patel and Theresa Pazionis
Global spine journal, 21925682261443916
22 Apr 2026
DOI: https://doi.org/10.1177/21925682261443916
PMID: 42015881
url
https://doi.org/10.1177/21925682261443916View
Published, Version of Record (VoR) Open CC BY-NC-ND V4.0

Abstract

high density lipoprotein cholesterol lumbar fusion lumbar spine surgery nonunion pseudoarthrosis
Study Design Retrospective cohort. Objectives Although dyslipidemia has been implicated in impaired bone healing, the role of high-density lipoprotein cholesterol (HDL-C) in spinal fusion outcomes remains poorly defined. Emerging evidence suggests that extremely elevated HDL-C levels may be associated with adverse osseous events. The objective of this study was to evaluate the association between HDL-C levels and rates of pseudoarthrosis and reoperation following single-level lumbar interbody fusion. Methods The TriNetX Research Network was queried for adult patients who underwent single level lumbar fusion during the 20-years period ended December 2, 2023. The high HDL-C cohort was designated by HDL-C ≥70.1 mg/dL, reflecting one standard deviation above the mean for all patients in the database. One standard deviation below the mean denoted the low HDL-C group (≤32.1 mg/dL). Propensity score matching was performed 1:1 according to demographics and comorbidities. Pseudoarthrosis diagnosis and reoperation were assessed at 6 months, 1 year, and 2 years postoperatively utilizing risk ratios (RR) and 95% confidence intervals (CI). Results After propensity matching, 1316 patient pairs were included. Patients with elevated HDL-C demonstrated significantly higher rates of pseudoarthrosis at 6 months, 1 year, and 2 years postoperatively. Early reoperation risk was also significantly increased in the high HDL-C cohort within 6 months, though differences were not sustained at later time points. Conclusions Elevated HDL-C was independently associated with increased risk of pseudoarthrosis following single-level lumbar fusion. These findings suggest that HDL-C may represent an underrecognized metabolic risk factor for impaired spinal fusion and warrants further investigation into underlying mechanisms and its possible utility in preoperative optimization programs.

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