Opioid and Neuropathic Pain Medication Use After ACDF for Degenerative Cervical Spine Disease-Nationwide FinSpine...

Longitudinal, nationwide register study.

To examine the use of opioids and neuropathic pain medications after primary anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease (DCSD), and to identify independent factors associated with postoperative use.

ACDF is used for cervical radiculopathy and myelopathy, yet many patients continue analgesic use postoperatively. Prolonged opioid use is associated with dependence, poorer clinical outcomes, and reduced return-to-work rates. Evidence on postoperative medication trajectories and their predictors in population-based cohorts remains limited.

Data were obtained from the nationwide FinSpine register and the Finnish prescription database, which records all outpatient prescription drug purchases. Consecutive patients undergoing primary ACDF for DCSD between 2017 and 2022 were included. Repeated purchases were defined as at least two purchases of the same drug during months 2 to 12 postoperatively. New strong-opioid users were defined as patients who were strong-opioid naïve six months preceding surgery and met the repeated postoperative purchase criterion. Multivariable logistic regression was used to identify independently associated covariates.

The cohort included 4366 patients. Preoperatively, 41.9% (n=1830) purchased opioids and 41.2% (n=1798) gabapentinoids. Repeated postoperative purchases were observed in 16.5% for opioids and 15.6% for gabapentinoids. Among preoperative opioid and gabapentinoid users, cessation rates were 69.5% and 70.9%, respectively. In previously strong-opioid naïve patients, the incidence of new repeated strong-opioid purchases was 2.2% after ACDF. Independent predictors of repeated postoperative purchases included preoperative pain duration of more than one year, smoking, higher baseline NDI, central canal stenosis, adverse working status, and preoperative purchases of the same drug class.

A considerable proportion of patients continued to purchase opioids and gabapentinoids during the first postoperative year after ACDF. New strong-opioid initiation postoperatively was uncommon. Nationwide prescription data offer an objective and complete measure of postoperative medication dispensing for outcome assessment.