Cutting Back on Cuts: Can Endoscopic Spine Surgery Reduce Chronic Opioid Use?

Introduction: Despite the morbidity and mortality associated with opioids, they are commonly prescribed following spine surgery. Endoscopic and minimally invasive surgeries (MIS) are increasingly common because they decrease complications, recovery time, and pain. It has yet to be determined how postoperative opioid use differs between MIS tubular decompression and endoscopic techniques. Here, we investigate and compare postoperative opioid use in minimally invasive and endoscopic spine surgery.

Methods: We retrospectively reviewed endoscopic lumbar spine surgeries performed at our tertiary care center from 2023-2024 (n=93) and collected data on 100 MIS surgeries between 2021-2024 to serve as a comparison group. We collected data on opioid prescriptions at discharge, length of opioid use, and chronic opioid use (≥3 months). We excluded patients without data on postoperative opioid use and conducted statistics with SPSS.

Results: 81 endoscopic patients (87%) and 93 MIS patients (92%) were prescribed opioids upon discharge. While there was no significant association (p=0.35, X2=0.88) nor correlation (p=0.35, ρ = -0.068) between type of surgery and postoperative opioid use, MIS patients had a significantly longer average length of use (p < 0.001). Specifically, average length of opioid use in MIS patients was 5.58 months, versus 1.65 months for endoscopic patients. Additionally, MIS patients were significantly more likely to chronically use opioids, defined as use greater than 3 months (p < 0.001). 48 of 92 (52%) MIS patients used narcotics for ≥3 months, versus 19 of 80 (24%) endoscopic patients.

Conclusion : Chronic opioid use was more common following MIS than endoscopic spine surgery. MIS patients used narcotics for almost 4 months longer than endoscopic patients. The minimal manipulation of soft tissues and muscles during endoscopic surgery likely shortens recovery time and causes less postoperative pain, resulting in less reliance on narcotics. Large-scale prospective studies should examine whether endoscopic surgery is truly associated with a lower risk of chronic opioid use after spine surgery.