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Abstract

Background: Spinal fusion is a common intervention for adolescent scoliosis, particularly during periods of rapid skeletal growth in patients with progressive curves or those who do not meet criteria for non-operative management. Adolescents receiving puberty suppression with gonadotropin-releasing hormone (GnRH) analogs as part of gender-affirming care present unique clinical challenges due to altered bone metabolism and delayed physeal (growth plate) maturation.

Methods: We conducted a narrative review of the current literature evaluating the effects of puberty blockers and gender-affirming hormone therapy (GAHT) on bone metabolism, skeletal development, and outcomes related to spinal fusion in adolescents.

Results: GnRH analogs are associated with delayed bone maturation and reduced peak bone mass accrual. The impact of GAHT, particularly estrogen and testosterone, on bone mineral density is variable and not fully understood. There is limited evidence regarding how these therapies affect spinal fusion healing, intraoperative risks, and postoperative recovery. Key perioperative concerns include impaired bone healing, increased thromboembolic risk, and altered pharmacodynamics.

Conclusions: Adolescents undergoing spinal fusion who are also receiving puberty suppression require individualized, multidisciplinary management. Optimizing surgical outcomes in this population demands careful coordination across specialties. Further research is needed to inform evidence-based clinical decision-making and improve perioperative care and long-term outcomes

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Clinical Considerations for Spinal Fusion in Adolescents on Puberty Blockers: Hormonal and Surgical Implications

Background: Spinal fusion is a common intervention for adolescent scoliosis, particularly during periods of rapid skeletal growth in patients with progressive curves or those who do not meet criteria for non-operative management. Adolescents receiving puberty suppression with gonadotropin-releasing hormone (GnRH) analogs as part of gender-affirming care present unique clinical challenges due to altered bone metabolism and delayed physeal (growth plate) maturation.

Methods: We conducted a narrative review of the current literature evaluating the effects of puberty blockers and gender-affirming hormone therapy (GAHT) on bone metabolism, skeletal development, and outcomes related to spinal fusion in adolescents.

Results: GnRH analogs are associated with delayed bone maturation and reduced peak bone mass accrual. The impact of GAHT, particularly estrogen and testosterone, on bone mineral density is variable and not fully understood. There is limited evidence regarding how these therapies affect spinal fusion healing, intraoperative risks, and postoperative recovery. Key perioperative concerns include impaired bone healing, increased thromboembolic risk, and altered pharmacodynamics.

Conclusions: Adolescents undergoing spinal fusion who are also receiving puberty suppression require individualized, multidisciplinary management. Optimizing surgical outcomes in this population demands careful coordination across specialties. Further research is needed to inform evidence-based clinical decision-making and improve perioperative care and long-term outcomes

 

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