Pre-operative Opioid Use Associated with Worsened Outcomes in Patients Undergoing Stand-alone Lateral Lumbar Interbody Fusion for Degenerative Disc Disease

Presented at SMISS Annual Forum 2018
By David Salvetti MD
With Alp Ozpinar MD, Nima Alan MD, David O Okonkwo , Adam Kanter MD, D. Kojo Hamilton ,

Disclosures: David Salvetti MD None Alp Ozpinar MD None, Nima Alan MD None, David O Okonkwo None, Adam Kanter MD None, D. Hamilton None,

Introduction:

Outcomes in spine surgery may benefit from pre-operative optimization of medical comorbidities, nutritional status, and weight management. With increasing concern over prescription opioid dependence for chronic conditions such as back pain, it is critical to understand how this may affect spine surgery outcomes.

Aims/Objectives:

The aim of this study is to evaluate whether post-operative outcomes are linked to pre-operative opioid dependence following lateral lumbar interbody fusion (LLIF).

Methods:

A consecutive series of 48 patients from a single institution undergoing LLIF for degenerative spondylosis were identified and retrospectively analyzed. Patients were categorized according to the presence or absence of prescribed pre-operative opioid use of greater than 6 months duration. Basic demographic data was collected as well as pre- and post-operative outcome measures including Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and Short Form 36 Physical and Mental Summary Scores (SF36-PCS, SF36-MCS). Statistical comparisons between groups were performed using an analysis of variance (ANOVA).

Results:

Of the 48 patients, (23 male, 25 female) mean age was 48.2 ± 14.6 years. The mean clinical follow up period was 14.1 months with the mean number of levels operated upon being 2 (range 1-4). Twenty-two patients (45%) were prescribed preoperative opioids for >6 months with a mean oral morphine equivalent of 14.3±11.4mg/day. Mean preoperative ODI was 46.1±12.9 (non-opioid 43.8±11.8, opioid 48.9±14, p=0.198). Mean postoperative ODI was 28.7±16.4 (non opioid 22.2±14.7, opioid 36.5±15.6, p=.003). There was a trend in the change in postoperative from preoperative ODI, with the non-opioid group showing a greater magnitude of improvement (-21.6±17.6 vs. -12.4±17.4, p=0.089). Mean preoperative VAS was 6.6±2.0 (non-opioid 6.5±1.9, opioid 6.7±1.0, p=0.802), and mean postoperative VAS was 4.1±2.3 (non-opioid 3.2±2.1, opioid 4.1±2.1, p=0.005). There was a statistically significant change in postoperative from preoperative VAS, with the non-opioid group showing a greater subjective decrease in pain (-3.3±2.4, -1.6±2.6, p=0.032). The differences from pre and post-operative SF36-PCS and SF36-MCS scores were not significantly different overall or by opioid use group.

Conclusions:

Preoperative opioid use correlated with less benefit in health-related quality of metrics following LLIF for degenerative spondylosis. Further study is required to identify whether strategies to wean preoperative opioids could negate this association.