Opioid Use in Opioid Naive Patients After Minimally Invasive Spine Surgery.

Area of Science:

• Orthopedics
• Neurosurgery
• Pain Management

Background:

• Postoperative opioid use after spine surgery is a significant concern.
• Opioid-naive patients represent a critical group for evaluating initial opioid prescribing practices.

Purpose of the Study:

• To assess postoperative opioid consumption in opioid-naive patients undergoing lumbar or cervical spine surgery.
• To compare opioid use between open and minimally invasive surgical approaches (tubular, endoscopic).
• To evaluate the impact of the number of operative levels on opioid requirements.

Main Methods:

• Prospective cohort study of 217 opioid-naive patients from August 2023 to December 2024.
• Stratification by surgical approach (open, tubular, endoscopic) and procedure extent (single-level vs. multilevel).
• Opioid usage quantified in morphine milligram equivalents (MME) via patient reports at 2 weeks and 3 months.

Main Results:

• Single-level procedures consumed less opioids (75.1 MME) than multilevel procedures (167.3 MME; P = .0068).
• Among lumbar surgeries, endoscopic procedures showed the lowest opioid use (48.6 MME) compared to open procedures (164.7 MME; P = .0021).
• 17.5% of patients required no postoperative opioids, with 36.3% in the single-level endoscopic group being opioid-free.

Conclusions:

• Minimally invasive spine surgery, particularly endoscopic and tubular techniques, is linked to reduced postoperative opioid use.
• Multilevel surgeries are associated with higher opioid consumption.
• Findings support tailored opioid prescribing protocols and patient education to minimize opioid reliance post-spine surgery.