Friend or Foe: The Use of Cannabis as a Potential Analgesic in Postoperative Lumbar Spine Surgery.

Tuluca A.; Boyce J.; Schneider G.; Williams E. · Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026

**Background & Methods** This is a literature review that consolidates existing research on cannabis use perioperatively and its potential utility as a postoperative analgesic in patients undergoing lumbar spine surgery. The review critically examines current evidence from review articles, systematic reviews, and retrospective studies to evaluate the efficacy and safety profile of cannabis in this surgical population. **Key Findings** • Cannabis has documented medicinal use dating back approximately 5000 years, with renewed clinical interest emerging following California's legalization in 1996 under the Compassionate Use Act; as of November 2023, 24 states, two territories, and Washington D.C. have legalized medical and/or recreational cannabis use. • Multiple current review articles, systematic reviews, and retrospective analyses suggest deleterious effects in patients undergoing lumbar spine surgery who use cannabis, though specific mechanisms and clinical outcomes require clarification. • A significant gap exists in level I evidence regarding cannabis as a perioperative pain mitigator, resulting in inconclusive recommendations about its clinical utility in postoperative lumbar spine surgery and highlighting the need for higher-quality studies. **Dosage & Administration** Not reported. The review does not specify cannabis dosages, routes of administration, or treatment protocols for postoperative pain management. **Safety & Adverse Effects** Not reported in detail. The abstract indicates that multiple studies suggest "deleterious effects" in lumbar spine surgery patients who use cannabis, but specific adverse effects are not enumerated in the provided abstract. **Evidence Quality** This literature review is limited by the lack of level I evidence (randomized controlled trials) in the current cannabis analgesia literature. The review identifies conflicting research findings and acknowledges significant evidence gaps regarding perioperative cannabis use in spine surgery patients. The authors note that existing evidence comes primarily from lower-level studies (reviews, systematic reviews, and retrospective analyses), which limits the ability to generate definitive clinical recommendations. The review's primary contribution is highlighting these limitations and identifying areas requiring rigorous future investigation to clarify whether cannabis represents a beneficial or harmful intervention in postoperative lumbar spine pain management.

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