Comparison of vicious effect of oral pantoprazole and famotidine on new bone formation in patients with lumbar spine fusion surgery: a randomized control trial

Background and Aim: Due to the increasing use of pump inhibitors (PPIs) and their side effects for bone repair and the high percentage of therapy failure in lumbar fusion surgery especially in various animal studies, the goal of this study was to appraise the consequence of pantoprazole and famotidine on new bone formation in patients experiencing spinal fusion surgery. Methods and Materials/Patients: In a double-blind clinical trial eighty patients participated in the study based on the inclusion and exclusion criteria. Forty of them received pantoprazole (group P) and ۴۰ received famotidine (group F) for eight weeks. They were followed up three, six and twelve months after surgery for cage subsidence, screw loosening, and Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Brantigan, Steffee, Fraser (BSF) and Lenke classification for grading their bone formation. A P-value <۰.۰۵ was reflected significant. Results: The rate of fusion based on the Lenke score was lower in the group receiving pantoprazole six and ۱۲ months after the surgery compared to group F (The frequency of Lenke grade C and D were ۳۵% and ۲۵% compared to the famotidine group ۱۲.۵% ​​and ۱۲.۵% respectively; P=۰.۰۴۲). The VAS score mean (SD) in group F was lower than group P after ۱۲ months [۲.۴۸ (۱.۰۶) and ۱.۸۳ (۰.۵۵) respectively; P=۰.۰۰۸]. There was no pharmacologically significant association with subsidence (P=۰.۴۳), loosening (P=۰.۱۳), ODI (P=۰.۳۱), and BSF (P=۰.۷۷) three, six, and ۱۲ months post-operation. Conclusion: Affording to the preliminary conclusions of this study, the use of pump inhibitors such as pantoprazole is more destructive for the ossification process in candidates of spinal fusion requiring the chronic use of drugs for controlling their gastric acid secretion, and H۲-blocking drugs such as famotidine are preferable in this situation after further investigations.

Keywords:

Pantoprazole Sodium , Famotidine Hydrochloride , Spinal Fusions