Introduction: Spinal cord stimulators (SCSs) and intrathecal drug delivery devices (IDDDs) are alternative treatments for chronic back pain, but little is known about their effect on chronic opioid use after subsequent spine surgery.
Methods: We conducted a retrospective matched comparison of implanted (SCS [n=11] or IDDD [n=3]) and non-implanted ASD patients (n=40) who underwent corrective spine surgery at a single center. We evaluated their intraoperative characteristics, long-term postoperative complications, radiographic correction, and chronic opioid use, measured as use on more than 50% of days for greater than 6 months pre- or postop and total morphine mg equivalents (MME) and MME per dose.
Results: There was no difference in the rate of chronic opioid use between the implanted and non-implanted ASD cohorts: 6m preop: 50% (n=7) vs 40% (n=16), admission: 71% (10) vs 45% (18), 6m postop: 64.3% (9) vs 32.5% (13), FFU: 64.3% (9) vs 37.5% (15), p>0.05. Similarly, there was no difference in Total MME: 6m preop: 101.3±177.8 vs 37.3±89.4, admission: 68.2±77.8 vs 45.3±129.9, 6m postop: 59.8±83.1 vs 20.8±46.9, FFU: 51.2±68.7 vs 31.1±55.5, p>0.05 for all. There was also no difference in MME per dose: 6m preop: 33.9 (49.2) vs 21.1 (58.2), admission: 55.1 (85.6) vs 20.4 (59.8), 6m postop: 18.3 (19.2) vs 11.1 (39.6), FFU: 19.7 (25.8) vs 8.9 (15.7), p>0.05 for all. We observed a trend of higher values in the implanted group at all timepoints. Implanted patients had higher OR time (implanted: 734.9 [103.4] vs non-implanted: 637.2 [147.8] min, p=0.0272), intraoperative blood requirement (2.1 [1.6] u pRBCs vs 1.1 [1.5] u, p=0.0500), and rate of dural tears (42.9% (6/14) vs 15% (6/40). Otherwise, their surgical outcomes, long-term complication rates and revision rates were equivalent.
Conclusion : Implanted ASD patients are not at increased risk for chronic opioid use and that they overall do not have worse postoperative compilation rates than non-implanted patients. High revision rates and prolonged postoperative opioid use illustrate the increased risk for chronic opioid use in the ASD population as a whole
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