Abstract
Introduction:Posterior cervical fusion (PCF) and anterior cervical diskectomy and fusion (ACDF) are two main surgical management options for the treatment of cervical spondylotic myelopathy. Although ACDF is less invasive than PCF which should theoretically reduce postoperative pain, it is still unknown whether this leads to reduced opioid use. Our objective was to evaluate whether PCF increases postoperative opioid use compared with ACDF.Methods:We retrospectively identified all patients undergoing 2-level to 4-level ACDF or PCF at a single center from 2017 to 2021. Our state's prescription drug-monitoring program was queried for filled opioid prescriptions using milligrams morphine equivalents (MMEs) up to 1 year postoperatively. In-hospital opioid use was collected from the electronic medical record. Bivariate statistics compared ACDF and PCF cohorts. Multivariate linear regression was done to assess independent predictors of in-hospital opioid use and short-term (0 to 30 days), subacute (30 to 90 days), and long-term (3 to 12 months) opioid prescriptions.Results:We included 211 ACDF patients and 91 PCF patients. Patients undergoing PCF used more opioids during admission (126.7 vs. 51.0 MME,P< 0.001) and refilled more MMEs in the short-term (118.2 vs. 86.1,P= 0.001) but not subacute (33.6 vs. 19.7,P= 0.174) or long-term (85.6 vs. 47.8,P= 0.310) period. A similar percent of patients in both groups refilled at least one prescription after 90 days (39.6% vs. 33.2%,P= 0.287). PCF (β = 56.7,P= 0.001) and 30-day preoperative MMEs (β = 0.28,P= 0.041) were associated with greater in-hospital opioid requirements. PCF (β = 26.7,P= 0.039), C5 nerve root irritation (β = 51.4,P= 0.019), and a history of depression (β = 40.9,P< 0.001) were independently associated with 30-day postoperative MMEs.Conclusions:PCF is initially more painful than ACDF but does not lead to persistent opioid use. Surgeons should optimize multimodal analgesia protocols to reduce long-term narcotic usage rather than change the surgical approach.Level of Evidence:III
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Orthopedics and Sports Medicine,Surgery
Reference40 articles.
1. Drug overdose deaths in the United States, 1999-2020;Hedegaard;NCHS Data Brief,2021
2. The drivers of persistent opioid use and its impact on healthcare utilization after elective spine surgery;Gerlach;Glob Spine J,2022
3. How good intentions contributed to bad outcomes: The opioid crisis;Rummans;Mayo Clinic Proc,2018
4. Sources of prescription opioids among diagnosed opioid abusers;Shei;Curr Med Res Opin,2015
5. The effect of online prescription drug monitoring on opioid prescription habits after elective single-level lumbar fusion;Siegel;J Am Acad Orthop Surg,2022