Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, was first described in the mid-19th century. A marked rise in incidence was observed in high-income countries during the second half of the 20th century. ^{Reference Kaplan and Ng1} This increase is thought to reflect a dysregulated mucosal immune response to the intestinal microbiome in genetically susceptible individuals, influenced by environmental factors such as the Western diet, smoking and improved hygiene. ^{Reference Hracs, Windsor and Gorospe2} More than 300,000 Canadians are currently living with IBD, and the prevalence is rising; projections estimate that 1 in 91 Canadians will be affected by 2035. ^{Reference Windsor, Kuenzig and Murthy3} The economic burden is substantial, exceeding $5 billion annually, with nearly half of direct healthcare costs attributable to biologic therapies. ^{Reference Windsor, Kuenzig and Murthy3,Reference Kuenzig, Coward and Targownik4} These agents have driven a paradigm shift from “rescue” treatment to early disease modification.

These trends are highly relevant to spine surgeons. Patients with IBD represent a growing population of medically complex individuals undergoing elective lumbar procedures. Perioperative risk is influenced by a multifactorial interplay between disease activity, nutritional status, systemic inflammation, immunomodulatory therapy, and spondyloarthropathy. These variables complicate surgical decision-making and postoperative care.

Nyugen et al. ^{Reference Nyugen, Quon and Ong5} present a timely systematic review and meta-analysis of four retrospective studies evaluating postoperative outcomes following lumbar spine surgery in patients with and without IBD. A consistent signal was identified toward increased perioperative morbidity among patients with IBD, including higher rates of infectious, thromboembolic, renal and cardiovascular complications. Importantly, these findings suggest that risk extends beyond surgical site complications, reflecting broader systemic vulnerability.

Several study limitations warrant consideration. Substantial heterogeneity across outcomes raises concern that pooled estimates may obscure important differences in study design, patient populations and surgical approaches. The absence of data on disease activity, medication exposure and nutritional status limits identification of modifiable risk factors. The observed discordance between increased complication rates and unchanged readmission rates may in part reflect the inherent limitations of administrative datasets; complications may be variably coded, whereas readmissions are more reliably captured.

These findings should be considered hypothesis-generating. Future research should prioritize granular prospective studies incorporating disease severity and medication management. Data related to procedure-specific effects and patient-reported outcomes should facilitate the estimation of true clinical impact.

Despite the aforementioned limitations, this study highlights the importance of recognizing IBD as a marker of increased perioperative risk, provides a valuable synthesis of existing evidence and identifies key gaps necessary to guide future clinical decision-making.