Neurosurgeon Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA. Tampa, FL, US
Introduction: The opioid crisis emphasizes the need to reduce opioid prescriptions post-surgery. Managing pain after adult spinal deformity (ASD) surgery is challenging due to procedural complexity and preoperative pain. Minimally invasive spine surgery (MIS) has gained popularity for reducing recovery time and complications, potentially lowering opioid use. However, its efficacy in pain management compared to traditional open surgery, which may offer superior deformity correction, remains unclear. This study compares postoperative pain and opioid use between MIS and open surgery in ASD patients.
Methods: A retrospective analysis was conducted on adults undergoing ASD surgery between 2016-2023 at our center. Patients were categorized into MIS (n=36) and open surgery (n=194). ASD was defined as any spinal construct from L2 to the pelvis with posterior instrumented fixation or greater. Pain was measured using the visual analogue scale (VAS) for back and leg pain, while opioid use and chronic opioid use (≥3 months post-op) were also recorded. Statistical analysis was performed with SPSS, with significance set at p< 0.05.
Results: Open surgery resulted in significantly lower postoperative pain at 3 months. Open surgery patients had lower back VAS (1.59) and leg VAS (0.88) scores compared to MIS patients, who reported back VAS of 2.72 and leg VAS of 1.89 (p < 0.001). There was no significant difference in opioid use (p=0.07) or chronic opioid use (p=0.70) between the groups.
Conclusion : Open surgery offers better pain relief than MIS in ASD, likely due to superior spinopelvic alignment correction. While MIS minimizes tissue damage, its limitations in deformity correction may affect postoperative outcomes. Future studies should explore improving deformity correction in MIS without compromising its minimally invasive benefits.