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Observational Study
. 2024 Jan 1;49(1):15-21.
doi: 10.1097/BRS.0000000000004799. Epub 2023 Aug 15.

Pain Medication Use Two Years After Adolescent Idiopathic Scoliosis Fusion Surgery

Tracey P Bastrom  1 , Michael P Kelly  1   2 , Vidyadhar V Upasani  1   2 , Peter O Newton  1   2 ; Harms Study Group
Collaborators, Affiliations
Observational Study

Pain Medication Use Two Years After Adolescent Idiopathic Scoliosis Fusion Surgery

Tracey P Bastrom et al. Spine (Phila Pa 1976). .

Abstract

Study design: Observational case control.

Objective: The objective of this study was to evaluate the prevalence of opioid use two years after surgical correction of adolescent idiopathic scoliosis (AIS) and its association with preoperative mental health.

Summary of background data: Studies of opiate use have reported that up to 80% of users began their addiction with misuse of prescription opioids. Identifying opioid use and those at risk in the AIS population is critical for optimal outcomes.

Materials and methods: A query of a multicenter prospective AIS surgical fusion registry was performed to identify patients of all curve types with responses to question 11 on the Scoliosis Research Society-22 questionnaire at two years postoperative. Question 11 asks about pain medication usage for the patient's back with five specific responses: narcotics daily, narcotics weekly or less, non-narcotics daily, non-narcotics weekly/less, or none. Ordinal regression was used to evaluate the association between preoperative Scoliosis Research Society-22 Mental Health (MH) domain scores and two-year postoperative pain medication usage.

Results: A total of 2595 patients who underwent surgery from 2002 to 2019 met inclusion. The average primary curve was 56±12°, average age 14.7±3 years, and 81.5% were female. Forty (1.5%) patients reported utilizing opioids two years after surgery, and a significant difference in preoperative MH scores was observed. Patients taking daily opioids postoperatively had the lowest median preoperative MH score (3.75), followed by non-narcotic group (4), and no medication (4.2, P <0.001). Three patients reporting opioid use postoperatively reported preoperative usage. The rate of two-year postoperative medication use based on the year of surgery demonstrated a small linear decrease in opioid use over time, with a slight increase in nonopioid daily use.

Conclusions: Less than 2% of patients reported taking opioids for back pain two years after surgical correction of AIS. A lower MH score before surgery may place a patient at increased risk for opioid use two years after surgery. An analysis of the year of surgery suggests that changes in prescription practices over time may be occurring.

Level of evidence: 4.

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Conflict of interest statement

P.O.N. Conflicts outside of the submitted work DePuy Synthese Spine: Grant paid to institution/research support, royalties, or licenses paid to me, consulting fees, speakers bureau, payment for development of educational programs, patents: Anchoring systems and methods for correcting spinal deformities (8540754); Low-profile spinal tethering systems (8123749); screw placement guide (79811117); compressor for use in minimally invasive surgery (7189244). Scoliosis Research Society: Grant paid to institution, board membership. EOS Imaging: Grant paid to institution. Nuvasive: Grant paid to institution. Orthopediatrics: Grant paid to institution. Stryker/K2M: Grant paid to institution, royalties or licenses paid to me, consulting fees, and patent: Posterior spinal fixation. Alphatech: Grant paid to institution. Mazor Robotics: Grant paid to institution. Setting Scoliosis Straight Foundation: Grants paid to institution, board membership (unpaid). Thieme Publishing: Royalties or licenses paid to me. Cubist: Consulting fees, participation on a Data Safety Monitoring Board. Mirus: Consulting fees. Globus Medica: Consulting fees. Pacira: Consulting fees. International Pediatric Orthopedic Think Tank: Board membership (unpaid). Electrocore: Stock or stock options. Rady Children's Specialists of San Diego: Board membership (unpaid). The remaining authors report no conflicts of interest.

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