Hardware Failure Drives Long-Term Opioid Use After Adult Spinal Deformity Surgery

Introduction: Adult spinal deformity (ASD) surgery involves extensive spinal realignment to correct distorted spinopelvic parameters, often resulting in significant postoperative pain necessitating opioid management. Complications such as hardware failure (HF), occurring in up to 40% of patients, can exacerbate pain and potentially increase opioid reliance.

Methods: We conducted a retrospective review of all ASD surgeries at our institution from 2016 to 2023 (n=263), involving multilevel fusions for scoliosis and/or kyphosis correction in adults. Data included chronic opioid use (≥ 3 months postoperatively) and complications like wound infection, proximal junctional kyphosis (PJK), and HF (rod fracture, screw fracture, pseudoarthrosis, pullout, or reoperation for HF). Patients without complete data were excluded. Statistical analyses utilized SPSS software.

Results: Of 263 patients, 231 (88%) used opioids postoperatively for an average of 26 months. Complications did not predict opioid use duration (p=0.84) or chronic use incidence (p=0.75). However, longer opioid use correlated significantly with HF (p=0.040), pseudoarthrosis/pullout (p < 0.001), and HF reoperation (p < 0.001). HF (p=0.040, X2=6.45) and HF reoperation (p=0.004, X2=10.90) significantly predicted chronic opioid use, with 89% and 100% of respective patients using opioids for ≥3 months post-surgery.

Conclusion : Patients experiencing HF or requiring HF reoperation demonstrate prolonged postoperative opioid use. HF likely contributes to increased pain and disease progression, influencing heightened opioid dependence post-surgery.