Chronic Opioid Use Following Endoscopic and Minimally Invasive Spine Surgery

Introduction: Prescription opioids are the primary etiology of opioid addiction and overdose in the United States. Providers must balance postoperative pain management and narcotic prescription minimization. Recent studies suggest that less invasive procedures are associated with decreased opioid use. We seek to investigate risk factors associated with chronic opioid use following endoscopic and minimally invasive (MIS) tubular laminectomies and discectomies.

Methods: We conducted a retrospective review of all endoscopic lumbar spine laminectomies and discectomies from 2023-2024 and MIS tubular laminectomies and discectomies conducted at our tertiary care center from 2021-2024. Data on opioid use/prescription was collected. We defined chronic opioid use as the consumption of opioids for >3 months postoperatively. Only patients with complete data on postoperative opioid use were included. Chi-square and descriptive analysis were conducted using SPSS.

Results: 92 patients operated through endoscopic laminectomies or discectomies, and 101 patients who underwent MIS tubular laminectomies or discectomies were included. Of the MIS cohort, we found a statistically significant increased rate of prolonged narcotic use in patients undergoing laminectomies compared to discectomies (p=0.02). Postoperative dysesthesia was also significantly associated (p=0.02). Of the endoscopic cohort, previous illicit drug use (p=0.04), preoperative narcotic use (p=0.05), and perioperative infection (p=0.01) were associated with significantly longer use of narcotics postoperatively. BMI >30 was identified as a risk factor for chronic opioid use for both MIS and endoscopic patients (p=0.04). Both smoking (p=0.02) and preoperative use of narcotics (p < 0.01) were significantly associated with chronic opioid use. Further stratification by MIS and endoscopic techniques revealed that these relationships were driven by endoscopic (p=0.01 for smoking and p< 0.01 for preoperative narcotics) but not MIS patients (p=0.372 for smoking and p=0.165 for preoperative narcotics).

Conclusion : Risk factors for chronic opioid use following spine surgery differ between endoscopic and MIS surgery. Providers should be aware that variables including preoperative opioid use, smoking and high BMI in patients undergoing endoscopic surgery, and postoperative dysesthesia in MIS patients may be linked to a higher risk of opioid addiction, misuse, and overdose.