Opioid Use Prior to Adult Spine Deformity Correction Surgery is Associated With Worse Pre- and Postoperative Back Pain and Prolonged Opioid Demands

Juan P. Sardi, Justin S. Smith, Jeffrey L. Gum, Brett Rocos, Anastasios Charalampidis, Lawrence G. Lenke, Christopher I. Shaffrey, Kenneth M.C. Cheung, Yong Qiu, Yukihiro Matsuyama, Ferran Pellisé, David W. Polly, Jonathan N. Sembrano, Benny T. Dahl, Michael P. Kelly, Marinus de Kleuver, Maarten Spruit, Ahmet Alanay, Sigurd H. Berven, Stephen J. Lewis

Research output: Contribution to journalArticlepeer-review


Study Design: Prospective multicenter database post-hoc analysis. Objectives: Opioids are frequently prescribed for painful spinal conditions to provide pain relief and to allow for functional improvement, both before and after spine surgery. Amidst a current opioid epidemic, it is important for providers to understand the impact of opioid use and its relationship with patient-reported outcomes. The purpose of this study was to evaluate pre-/postoperative opioid consumption surrounding ASD and assess patient-reported pain outcomes in older patients undergoing surgery for spinal deformity. Methods: Patients ≥60 years of age from 12 international centers undergoing spinal fusion of at least 5 levels and a minimum 2-year follow-up were included. Patient-reported outcome scores were collected using the Numeric Rating Scale for back and leg pain (NRS-B; NRS-L) at baseline and at 2 years following surgery. Opioid use, defined based on a specific question on case report forms and question 11 from the SRS-22r questionnaire, was assessed at baseline and at 2-year follow-up. Result: Of the 219 patients who met inclusion criteria, 179 (81.7%) had 2-year data on opioid use. The percentages of patients reporting opioid use at baseline (n = 75, 34.2%) and 2 years after surgery (n = 55, 30.7%) were similar (P =.23). However, at last follow-up 39% of baseline opioid users (Opi) were no longer taking opioids, while 14% of initial non-users (No-Opi) reported opioid use. Regional pre- and postoperative opioid use was 5.8% and 7.7% in the Asian population, 58.3% and 53.1% in the European, and 50.5% and 40.2% in North American patients, respectively. Baseline opioid users reported more preoperative back pain than the No-Opi group (7.0 vs 5.7, P =.001), while NRS-Leg pain scores were comparable (4.8 vs 4, P =.159). Similarly, at last follow-up, patients in the Opi group had greater NRS-B scores than Non-Opi patients (3.2 vs 2.3, P =.012), but no differences in NRS-Leg pain scores (2.2 vs 2.4, P =.632) were observed. Conclusions: In this study, almost one-third of surgical ASD patients were consuming opioids both pre- and postoperatively world-wide. There were marked international variations, with patients from Asia having a much lower usage rate, suggesting a cultural influence. Despite both opioid users and nonusers benefitting from surgery, preoperative opioid use was strongly associated with significantly more back pain at baseline that persisted at 2-year follow up, as well as persistent postoperative opioid needs.

Original languageEnglish (US)
JournalGlobal Spine Journal
StateAccepted/In press - 2024

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© The Author(s) 2024.


  • adult spinal deformity
  • opioid use
  • pain management
  • pain measurement
  • spinal instrumentation
  • spine surgery


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