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No link found between poor results from anterior cervical procedures and preoperative opioid strength
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A retrospective review of 1,004 patients who underwent anterior decompressive surgery for single-level cervical disease causing myelopathy or radiculopathy showed the strength of the patients’ preoperative opioid use did not adversely affect outcomes of their procedures.
Researchers used data from one of two investigational device exemption studies that compared the results of cervical total disc arthroplasty to those of anterior cervical discectomy and fusion. Prior to the procedures, patients were surveyed regarding their narcotic use. Using morphine equivalents and commonly prescribed doses, investigators categorized patients’ opioid use as “weak,” “strong” or “opioid naïve.” In addition, researchers noted patients’ Neck Disability Index (NDI) scores and numeric rating scale scores for neck and arm pain.
Overall, 226 patients had strong preoperative opioid use (oxycodone, morphine, meperidine), 762 patients had weak use (codeine, propoxyphene, hydrocodone) and 16 patients were opioid naïve. Investigators found patients taking higher strength opioids had higher NDI scores, and more neck and arm pain on average than those taking weaker opioids.
At 24-month follow-up, mean NDI improvement was 36.3 points in the strong and 33.5 points in the weak cohorts, which was not a significant difference. Researchers noted significant improvements in both arm and neck pain in all patients, and no changes in those improvements at any follow-up point. The success rates following the procedures were 80.6% in the strong opioid cohort, 82.7% in the weak opioid cohort and 73.3% in the opioid naïve cohort.
“Preoperative opioid strength did not adversely affect outcomes in this analysis,” the researchers wrote. “Careful patient selection can yield good results in this patient population.” – by Robert Linnehan
Disclosures: Kelly reports support from AO Spine, CSRS, OREF and Barnes Jewish Foundation for non-study-related clinical or research efforts. Please see the full study for a list of all other authors’ relevant financial disclosures.
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