From Incision to Prescription: Unraveling Pain and Opioid Use in Adult Spinal Deformity Surgery.

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2025-09-12 DOI:10.14444/8791

Samantha Schimmel, Molly Monsour, Kiana Yeganeh, Schahin Salmanian, Chloe Chose, Anjali Pradhan, Diego T Soto-Rubio, Cesar Carballo Cuello, Jay I Kumar, Puya Alikhani

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引用次数: 0

Abstract

Background: Adult spinal deformity (ASD) surgery often involves extensive spinal realignment to restore spinopelvic parameters and functional alignment. Unfortunately, patients frequently experience significant postoperative pain, often leading to prolonged opioid use. This study investigates patient- and surgery-related factors associated with opioid use and pain following ASD surgery.

Methods: We conducted a retrospective review of ASD cases performed at our institution between 2016 and 2023. All patients underwent multilevel spinal fusion for correction of scoliosis and/or kyphosis.

Results: Of the 264 patients, 231 (88%) required opioids postoperatively, and 22.4% remained on opioids at 12 months. Preoperative opioid use (P < 0.001), pelvic incidence (PI) <55° (P = 0.018) due to inability for pelvic retroversion, revision surgery for proximal junctional kyphosis (P = 0.006), and hardware failure (P < 0.001) were associated with prolonged opioid use. Notably, patients who underwent intradiscal osteotomy (IDO) had a shorter duration of opioid use due to more harmonious correction of their lumbar lordosis (P = 0.006). Pain scores were significantly higher in patients who underwent anterior column release (P < 0.001) and who experienced postoperative complications (proximal junctional kyphosis and hardware failure; P < 0.05). In contrast, patients treated with IDO or pedicle subtraction osteotomy reported lower pain (P < 0.05). In multivariable analysis, preoperative opioid use was the strongest independent predictor of 12-month use (OR = 3.95, P = 0.001), while PI > 55° was independently associated with decreased 12-month use (OR = 0.33, P = 0.009).

Conclusion: This study highlights several key risk factors for prolonged opioid dependence and elevated postoperative pain in ASD surgery, including preoperative narcotic use, postoperative PI < 55°, revision surgery for mechanical complications, and specific osteotomy techniques. The protective effect of IDO in reducing pain and opioid duration is most likely due to more harmonious correction of lumbar lordosis and an improvement in lumbar lordosis-PI mismatch.

Clinical relevance: These findings underscore the importance of preoperative optimization, opioid-sparing pain management strategies, and enhanced recovery pathways to mitigate long-term opioid reliance and improve patient outcomes.

Level of evidence: 3:

查看原文本刊更多论文

从切口到处方：成人脊柱畸形手术中疼痛和阿片类药物的使用。

背景：成人脊柱畸形（ASD）手术通常涉及广泛的脊柱调整，以恢复脊柱骨盆参数和功能对齐。不幸的是，患者经常经历明显的术后疼痛，往往导致阿片类药物使用时间延长。本研究调查了与ASD手术后阿片类药物使用和疼痛相关的患者和手术相关因素。方法：我们对2016年至2023年在我院进行的ASD病例进行回顾性分析。所有患者均行多节段脊柱融合术以矫正脊柱侧凸和/或脊柱后凸。结果：264例患者中，231例（88%）术后需要阿片类药物，22.4%在12个月时仍使用阿片类药物。术前阿片类药物的使用（P < 0.001）、盆腔无法后移导致的骨盆发生率（PI） P = 0.018、近端关节后凸的翻修手术（P = 0.006）和硬体故障（P < 0.001）与阿片类药物的长期使用相关。值得注意的是，接受椎间盘内截骨术（IDO）的患者使用阿片类药物的时间较短，因为他们的腰椎前凸得到了更和谐的矫正（P = 0.006）。前柱释放组和术后并发症（近端关节后凸和硬体失效；P < 0.05）患者的疼痛评分明显更高（P < 0.001）。相比之下，IDO或椎弓根减截骨术患者的疼痛程度较低（P < 0.05）。在多变量分析中，术前阿片类药物使用是12个月使用的最强独立预测因子（OR = 3.95, P = 0.001），而PI bb0 55°与12个月使用减少独立相关（OR = 0.33, P = 0.009）。结论：本研究强调了ASD手术中阿片类药物依赖延长和术后疼痛升高的几个关键危险因素，包括术前麻醉使用、术后PI < 55°、机械并发症的翻修手术和特定的截骨技术。IDO在减轻疼痛和阿片类药物持续时间方面的保护作用很可能是由于更和谐的腰椎前凸矫正和腰椎前凸- pi不匹配的改善。临床相关性：这些发现强调了术前优化、阿片类药物疼痛管理策略和增强恢复途径对减轻长期阿片类药物依赖和改善患者预后的重要性。证据等级：3；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.