{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:11:18Z","timestamp":1788667878737,"version":"build-2803163510"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether preoperative testosterone replacement therapy (TRT) use is associated with increased risks of pseudarthrosis and reoperation following single-level anterior cervical discectomy and fusion (ACDF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The TriNetX Research Network was queried to identify adult males aged 18 to 89 years who underwent single-level ACDF. Patients were separated into a TRT exposure group within 1 year before initial ACDF procedure as well as comparator cohort without TRT exposure that was matched 1:1 using propensity score matching based on age, race, and relevant medical comorbidities. Patients were followed longitudinally for 2 years from the index procedure to assess postoperative outcomes. The primary outcomes were pseudarthrosis and reoperation. Risk ratios and time-to-event hazard ratios were calculated along with 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After propensity score matching, 494 matched pairs reached balance across all baseline characteristics. Patients receiving TRT demonstrated a 70% increased risk of pseudarthrosis (RR 1.70, CI 1.20\u20132.39; HR 1.71 CI 1.19 \u2013 2.46) compared to the non-TRT cohort. TRT use was not associated with an increased risk of reoperation (RR 0.92 CI 0.59\u20131.43; HR 0.87, CI 0.55-1.38) following ACDF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preoperative testosterone replacement therapy was associated with increased risk of pseudarthrosis, but not reoperation following ACDF. These findings suggest that TRT may represent an important patient-specific risk marker in patients undergoing ACDF. Given the observational design and potential for residual confounding, these findings should not be interpreted as evidence of a causal effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261487188","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:04:15Z","timestamp":1788451455000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Testosterone Replacement Therapy is Associated With Increased Risk of Pseudarthrosis After Single-Level Anterior Cervical Discectomy and Fusion: A Propensity Matched Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2475-706X","authenticated-orcid":false,"given":"William","family":"Han","sequence":"first","affiliation":[{"name":"Lewis Katz School of Medicine at Temple University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Stump","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine at Temple University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Gubara","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine at Temple University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhat","family":"Gottipati","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine at Temple University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Aynaszyan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Pazionis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic 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