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Opioids and analgesics use after adult spinal deformity surgery correlates with sagittal alignment and preoperative analgesic pattern

  • Anouar BourghliEmail author
  • Louis Boissiere
  • Daniel Larrieu
  • Farah Kaissar
  • Derek Cawley
  • Takashi Fujishiro
  • David Kieser
  • Olivier Gille
  • Jean-Marc Vital
  • Ahmet Alanay
  • Ferran Pellisé
  • Emre Acaroglu
  • Francisco-Javier Perez-Grueso
  • Franck Kleinstück
  • Ibrahim Obeid
  • European Spine Study Group
Original Article

Abstract

Purpose

To assess pain, health-related quality of life (HRQOL) scores and sagittal parameters of adult spinal deformity (ASD)-operated patients in the context of their analgesic consumption especially opioids (narcotics) over the first year postoperative period.

Methods

In total, 372 patients from a multicenter database were stratified into 3 groups at baseline: 241 patients in the minimal group (no analgesic, or NSAIDs/narcotics weekly or less), 64 in the NSAIDs every day group and 67 in the narcotics every day group. HRQOL and back and leg pain scores were evaluated at 6 months and 1 year postoperatively. Also several sagittal alignment parameters were assessed.

Results

Significant improvements in pain and HRQOL scores were observed across all 3 groups by 1 year (P < 0.05) postoperatively. While the minimal group had the best pre- and postoperative HRQOL scores, the NSAID group demonstrated the best improvement in HRQOL. Only the minimal group displayed continued improvement from 6 months to 1 year. 90%, 65% and 40% of minimal, NSAID and narcotic groups of patients, respectively, no longer took any analgesics at 1 year postoperatively. Alternatively, 36% of patients in the narcotics group continued to take narcotics at 1 year. Residual malalignment increased NSAIDs consumption in different groups at 1 year.

Conclusion

This study evaluated the analgesics use after ASD surgery in relation to the clinical and radiological outcomes. Despite important postoperative opioids consumption in the narcotics group, clinical outcome yet improved. Malalignment parameters demonstrated a predictive value in regard to NSAIDs’ usage.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Opioids NSAID Adult spinal deformity Health-related quality of life scores Sagittal alignment 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6141_MOESM1_ESM.pptx (184 kb)
Supplementary material 1 (PPTX 184 kb)

References

  1. 1.
    Pellise F, Vila-Casademunt A, Ferrer M et al (2015) Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3–11CrossRefGoogle Scholar
  2. 2.
    Glassman SD, Berven S, Kostuik J, Dimar JR, Horton WC, Bridwell K (2006) Nonsurgical resource utilization in adult spinal deformity. Spine (Phila Pa 1976) 31:941–947CrossRefGoogle Scholar
  3. 3.
    Bess S, Boachie-Adjei O, Burton D et al (2009) Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Spine (Phila Pa 1976) 34:2186–2190CrossRefGoogle Scholar
  4. 4.
    Yoshida G, Boissiere L, Larrieu D et al (2017) Advantages and disadvantages of adult spinal deformity surgery and its impact on health-related quality of life. Spine (Phila Pa 1976) 42:411–419CrossRefGoogle Scholar
  5. 5.
    Scheer JK, Smith JS, Clark AJ et al (2015) Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction. J Neurosurg Spine 22:540–553CrossRefGoogle Scholar
  6. 6.
    Takemoto M, Boissiere L, Novoa F et al (2016) Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients. Eur Spine J 25:2442–2451CrossRefGoogle Scholar
  7. 7.
    Pincus T, Burton AK, Vogel S, Field AP (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976) 27:E109–E120CrossRefGoogle Scholar
  8. 8.
    Glassman SD, Schwab FJ, Bridwell KH, Ondra SL, Berven S, Lenke LG (2007) The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine (Phila Pa 1976) 32:93–97CrossRefGoogle Scholar
  9. 9.
    Smith JS, Fu KM, Urban P, Shaffrey CI (2008) Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 9:326–331CrossRefGoogle Scholar
  10. 10.
    Smith JS, Shaffrey CI, Berven S et al (2009) Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65:86–93 discussion -4 CrossRefGoogle Scholar
  11. 11.
    Mesfin A, Lenke LG, Bridwell KH et al (2014) Does preoperative narcotic use adversely affect outcomes and complications after spinal deformity surgery? A comparison of nonnarcotic- with narcotic-using groups. Spine J 14:2819–2825CrossRefGoogle Scholar
  12. 12.
    Smith JS, Shaffrey CI, Fu KM et al (2013) Clinical and radiographic evaluation of the adult spinal deformity patient. Neurosurg Clin N Am 24:143–156CrossRefGoogle Scholar
  13. 13.
    Smith JS, Klineberg E, Schwab F et al (2013) Change in classification grade by the SRS-Schwab adult spinal deformity classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spine (Phila Pa 1976) 38:1663–1671CrossRefGoogle Scholar
  14. 14.
    Smith JS, Shaffrey CI, Berven S et al (2009) Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976) 34:1693–1698CrossRefGoogle Scholar
  15. 15.
    Smith JS, Shaffrey CI, Glassman SD et al (2013) Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J 22:402–410CrossRefGoogle Scholar
  16. 16.
    Terran J, Schwab F, Shaffrey CI et al (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73:559–568CrossRefGoogle Scholar
  17. 17.
    Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN (2014) Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 348:g1251CrossRefGoogle Scholar
  18. 18.
    Brett DRLS, Abhishek K, Adam E, Wellington KH, Alpesh AP (2017) Risk factors for prolonged postoperative narcotic use after spine surgery. P405, AAOS 2017 annual meetingGoogle Scholar
  19. 19.
    Joseph SA Jr, Moreno AP, Brandoff J, Casden AC, Kuflik P, Neuwirth MG (2009) Sagittal plane deformity in the adult patient. J Am Acad Orthop Surg 17:378–388CrossRefGoogle Scholar
  20. 20.
    Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029CrossRefGoogle Scholar
  21. 21.
    Blondel B, Schwab F, Ungar B et al (2012) Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up. Neurosurgery 71:341–348 discussion 8 CrossRefGoogle Scholar
  22. 22.
    Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231CrossRefGoogle Scholar
  23. 23.
    Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606CrossRefGoogle Scholar
  24. 24.
    Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27:387–392CrossRefGoogle Scholar
  25. 25.
    Biller N, Arnstein P, Caudill MA, Federman CW, Guberman C (2000) Predicting completion of a cognitive-behavioral pain management program by initial measures of a chronic pain patient’ s readiness for change. Clin J Pain 16:352–359CrossRefGoogle Scholar
  26. 26.
    Stockl K, Cyprien L, Chang EY (2005) Gastrointestinal bleeding rates among managed care patients newly started on cox-2 inhibitors or nonselective NSAIDs. J Manag Care Pharm 11:550–558Google Scholar
  27. 27.
    Joshi GP, Gertler R, Fricker R (2007) Cardiovascular thromboembolic adverse effects associated with cyclooxygenase-2 selective inhibitors and nonselective antiinflammatory drugs. Anesth Analg 105:1793–1804 table of contents CrossRefGoogle Scholar
  28. 28.
    Dodwell ER, Latorre JG, Parisini E et al (2010) NSAID exposure and risk of nonunion: a meta-analysis of case-control and cohort studies. Calcif Tissue Int 87:193–202CrossRefGoogle Scholar
  29. 29.
    Maund E, McDaid C, Rice S, Wright K, Jenkins B, Woolacott N (2011) Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. Br J Anaesth 106:292–297CrossRefGoogle Scholar
  30. 30.
    American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older P. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009;57:1331–1346Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anouar Bourghli
    • 1
    Email author
  • Louis Boissiere
    • 2
  • Daniel Larrieu
    • 2
  • Farah Kaissar
    • 2
  • Derek Cawley
    • 2
  • Takashi Fujishiro
    • 2
  • David Kieser
    • 2
  • Olivier Gille
    • 2
  • Jean-Marc Vital
    • 2
  • Ahmet Alanay
    • 3
  • Ferran Pellisé
    • 4
  • Emre Acaroglu
    • 5
  • Francisco-Javier Perez-Grueso
    • 6
  • Franck Kleinstück
    • 7
  • Ibrahim Obeid
    • 2
  • European Spine Study Group
  1. 1.Orthopedic and Spinal Surgery DepartmentKingdom HospitalRiyadhSaudi Arabia
  2. 2.Orthopedic Spinal Surgery Unit 1Bordeaux Pellegrin HospitalBordeauxFrance
  3. 3.Spine Surgery UnitAcibadem Maslak HospitalIstanbulTurkey
  4. 4.Spine Surgery UnitHospital Universitario Val HebronBarcelonaSpain
  5. 5.Ankara Acibadem Spine CenterAnkaraTurkey
  6. 6.Spine Surgery UnitHospital Universitario La PazMadridSpain
  7. 7.Spine Center, Schulthess KlinikZurichSwitzerland

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