TY - JOUR
T1 - Preoperative opioid strength may not affect outcomes of anterior cervical procedures
T2 - A post hoc analysis of 2 prospective, randomized trials
AU - Kelly, Michael P.
AU - Anderson, Paul A.
AU - Sasso, Rick C.
AU - Riew, K. Daniel
N1 - Funding Information:
Medtronic provided direct research support for this project. Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Dr. Riew reports direct stock ownership in Amedica, Benvenue, Expanding Orthopedics, Nexgen Spine, Osprey, Paradigm Spine, Spinal Kinetics, Spineology, Vertiflex, and PSD; receiving research support for the study described from AO Spine, Cerapedics, Medtronic, OREF (Orthopaedic Research and Education Foundation), and Spinal Dynamics; receiving royalties and speaker honoraria from and/or being a board member for Biomet, Medtronic, Osprey, CSRS (Cervical Spine Research Society), Korean American Spine Society, Global Spine Journal, Spine Journal, AO Spine International, New England Spine Society Group, and North American Spine Society. Dr. Anderson reports being a consultant for Aesculap and Stryker; holding a patent with Stryker and RTI; having ownership in SI Bone, Spartec, Titan Spine, and Expanding Orthopedics. Dr. Kelly reports receiving support from AO Spine, CSRS, OREF, and Barnes Jewish Foundation for non-study-related clinical or research efforts.
Publisher Copyright:
©AANS, 2015.
PY - 2015/10
Y1 - 2015/10
N2 - OBJECT: The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery. METHODS: A retrospective cohort of 1004 patients enrolled in 1 of 2 investigational device exemption studies comparing cervical total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for single-level cervical disease causing radiculopathy or myelopathy was selected. At a preoperative visit, opioid use data, Neck Disability Index (NDI) scores, 36-Item Short-Form Health Survey (SF-36) scores, and numeric rating scale scores for neck and arm pain were collected. Patients were divided into strong (oxycodone/morphine/meperidine), weak (codeine/propoxyphene/hydrocodone), and opioid-naïve groups. Preoperative and postoperative (24 months) outcomes scores were compared within and between groups using the paired t-test and ANCOVA, respectively. RESULTS: Patients were categorized as follows: 226 strong, 762 weak, and 16 opioid naïve. The strong and weak groups were similar with respect to age, sex, race, marital status, education level, Worker's Compensation status, litigation status, and alcohol use. At 24-month follow-up, no differences in change in arm or neck pain scores (arm: strong -52.3, weak -50.6, naïve -54.0, p = 0.244; neck: strong -52.7, weak -50.8, naïve -44.6, p = 0.355); NDI scores (strong -36.0, weak -33.3, naïve -32.3, p = 0.181); or SF-36 Physical Component Summary scores (strong: 14.1, weak 13.3, naïve 21.7, p = 0.317) were present. Using a 15-point improvement in NDI to determine success, the authors found no between-groups difference in success rates (strong 80.6%, weak 82.7%, naïve 73.3%, p = 0.134). No difference existed between treatment arms (TDA vs ACDF) for any outcome at any time point. CONCLUSIONS: Preoperative opioid strength did not adversely affect outcomes in this analysis. Careful patient selection can yield good results in this patient population.
AB - OBJECT: The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery. METHODS: A retrospective cohort of 1004 patients enrolled in 1 of 2 investigational device exemption studies comparing cervical total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for single-level cervical disease causing radiculopathy or myelopathy was selected. At a preoperative visit, opioid use data, Neck Disability Index (NDI) scores, 36-Item Short-Form Health Survey (SF-36) scores, and numeric rating scale scores for neck and arm pain were collected. Patients were divided into strong (oxycodone/morphine/meperidine), weak (codeine/propoxyphene/hydrocodone), and opioid-naïve groups. Preoperative and postoperative (24 months) outcomes scores were compared within and between groups using the paired t-test and ANCOVA, respectively. RESULTS: Patients were categorized as follows: 226 strong, 762 weak, and 16 opioid naïve. The strong and weak groups were similar with respect to age, sex, race, marital status, education level, Worker's Compensation status, litigation status, and alcohol use. At 24-month follow-up, no differences in change in arm or neck pain scores (arm: strong -52.3, weak -50.6, naïve -54.0, p = 0.244; neck: strong -52.7, weak -50.8, naïve -44.6, p = 0.355); NDI scores (strong -36.0, weak -33.3, naïve -32.3, p = 0.181); or SF-36 Physical Component Summary scores (strong: 14.1, weak 13.3, naïve 21.7, p = 0.317) were present. Using a 15-point improvement in NDI to determine success, the authors found no between-groups difference in success rates (strong 80.6%, weak 82.7%, naïve 73.3%, p = 0.134). No difference existed between treatment arms (TDA vs ACDF) for any outcome at any time point. CONCLUSIONS: Preoperative opioid strength did not adversely affect outcomes in this analysis. Careful patient selection can yield good results in this patient population.
KW - Cervical arthroplasty
KW - Cervical fusion
KW - Narcotic
KW - Opioid
KW - Pain
UR - http://www.scopus.com/inward/record.url?scp=84964994170&partnerID=8YFLogxK
U2 - 10.3171/2015.1.SPINE14985
DO - 10.3171/2015.1.SPINE14985
M3 - Article
C2 - 26140401
AN - SCOPUS:84964994170
VL - 23
SP - 484
EP - 489
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
SN - 1547-5654
IS - 4
ER -