Introduction: There is a growing concern that the use of prescription opioids may predispose patients to hazardous opioid dependence. We
hypothesized that the use of preoperative narcotics may lead to poorer patient outcomes following stand-alone lateral interbody fusion (LIF) for lumbar degenerative disc disease.
Methods: A consecutive series of patients from a single institution undergoing standalone LIF were retrospectively analyzed. Patients
were categorized according to the presence or absence of prescribed preoperative opioid use >6months. Outcomes included
the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) and Short Form 36 Physical and Mental Summary Scores (SF36-
PCS, SF36-MCS). Change values were calculated between postoperative and preoperative outcomes indices. Between-group comparisons were performed using analysis of variance.
Results: Overall in 48 patients, (23 male, 25 female) mean age was 48.2 ±14.6-years; mean number of levels 2 (1-4) and 22 (45%) were
prescribed preoperative opioids, 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±14.0, p=0.198). Mean postoperative ODI was 28.7±16.4 (non-opioid 22.2±14.7,
opioid 36.5±15.6, p=0.003). Mean preoperative VAS 6.6±2.0 (nonopioid 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). There
was a marginally statistically significant 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). Changes scores for SF36-PCS and SF36-MCS were not statistically significant by opioid use group.
Conclusions: Preliminary data from a single center consecutive study onpatients undergoing LIF for lumbar degenerative disc disease suggest that patients prescribed preoperative opioids may suffer increased postoperative lumbar pain disability and subjective pain compared to patients not on preoperative opioids. Future studies are needed for confirmation.
Patient Care: If confirmed in larger prospective series, the statistical significant findings in this study can provide valuable information to neurosurgeons and primary care providers, proposing avoidance in narcotics for patients with lumbar degenerative disc disease.
Learning Objectives: By conclusion of this session, participants should be able to describe the effects of prolonged preoperative opioid use on
patient outcomes after LIF, and discuss whether early intervention when indicated could result in improved patient outcomes.