Complications associated with intrathecal morphine in spine surgery: a retrospective study

Supplemental intrathecal morphine (ITM) represents an option to manage postoperative pain after spine surgery due to ease of administration and ability to confer effective short-term analgesia at low dosages. However, whether ITM increases risk of surgical site infections (SSI), cerebrospinal fluid (CSF) leak, and incidental dural tears (IDT) has not been investigated. Therefore, this study was performed to determine the rates of SSI, CSF leak, and IDT in patients that received ITM.

Patients that underwent posterior instrumented fusion from January 2010 to 2016 that received ITM were compared to controls with respect to demographic, medical, surgical, and outcome data. Fisher's exact test was used to compare rates of SSI, CSF leak, and IDT between groups. Poisson regression was used to analyze complication rates after adjusting for the influence of covariates and potential confounders.

A total of 512 records were analyzed. ITM was administered to 78 patients prior to wound closure. The remaining 434 patients compromised the control group. IDT was significantly more common among patients receiving ITM (P=0.009). Differences in rates of CSF leak and SSI were not statistically significant (P=0.373 and P=0.564, respectively). After compensating for additional variables, Poisson regression revealed a significant increase in rates of IDT (P=0.007) according to ITM injection and advanced age (P=0.014). There was no significant difference in rates of CSF leak or SSI after accounting for the additional variables (P>0.05).

ITM for pain control in posterior instrumented spinal fusion surgery was linked to increased likelihood of IDT but not CSF leaks or SSI. Age was also noted to be a significant predictor of IDT. Spine surgeons should weigh potential risks against benefits when deciding whether to administer ITM for postoperative pain management following spine surgery.