Document Type

Article

Publication Date

3-18-2025

Comments

This article is the author's final published version in World Neurosurgery, Volume 196, 2025, Article number 123800.

The published version is available at https://doi.org/10.1016/j.wneu.2025.123800.

Copyright © 2025 The Authors

Abstract

OBJECTIVE: This study compared postoperative opioid use for patients undergoing short segment primary versus revision lumbar fusion.

METHODS: Patients who underwent primary or revision 1-2 level lumbar fusion (2017-2021) were included in this study. The state Prescription Drug Monitoring Program was reviewed for all patients to quantify preoperative and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use. A 1:1 propensity match was performed to match primary lumbar fusion patients with revision lumbar fusion patients. Revision lumbar fusion patients were substratified into those with or without persistent postoperative opioid use to identify demographic differences between these patient cohorts.

RESULTS: The final cohort included 216 primary and 216 revision 1-2 level lumbar fusion patients. The average time between index procedure and revision was 7.54 ± 9.22 years. Opioid use was similar within 1-year preoperatively and at all postoperative time points (up to 1 year) between primary and revision fusion patients. Benzodiazepine, muscle relaxants, and gabapentinoid use was also similar at all preoperative and postoperative time points. Further stratification of revision lumbar fusion patients found that persistent postoperative opioid use patients had a higher incidence of preoperative opioid use within the year prior to surgery with increased number of prescriptions (7.22 ± 7.62 vs. 1.38 ± 2.32; P < 0.001) and morphine milligram equivalents totals (298 ± 565 vs. 45.6 ± 84.4; P < 0.001).

CONCLUSIONS: Postoperative opioid requirements were similar amongst patients undergoing primary versus revision lumbar fusion. In the revision cohort, persistent postoperative opioid users had higher preoperative opioid use, which is supported by prior literature. Although revision lumbar fusion has been reported to lead to less pain improvement, this study's findings suggest these procedures may not lead to higher rates of persistent opioid use postoperatively.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

39971185

Language

English

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