Patients on Regular Preoperative Weak Opioid Intake Can Achieve Successful Surgical Outcomes After Posterior Decompression Surgery for Cervical Spondylotic Myelopathy.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To investigate the surgical outcomes of patients receiving regular weak opioids preoperatively in posterior decompression surgery for cervical spondylotic myelopathy.

SUMMARY OF BACKGROUND DATA: Several studies have reported that regular preoperative opioid intake is a risk factor for poor patient outcomes after spine surgery. However, the effect of preoperative weak opioid intake on the outcomes of patients with cervical spondylotic myelopathy, particularly those undergoing posterior decompression surgery without fusion remains unknown.

METHODS

We reviewed 211 patients with cervical myelopathy who underwent posterior cervical decompression surgery and divided them into 2 groups based on regular preoperative weak opioid intake. The Numerical Rating Scale (NRS score, 0-10) for neck pain, Neck Disability Index (NDI), and Euro-Quality of Life 5-Dimensions (EQ-5D) scores were compared between the 2 groups. Preoperative oral analgesic intake was also assessed.

RESULTS

All twenty patients who had taken opioids regularly were using tramadol. Patients were divided into tramadol (+) or tramadol (-) group based on regular preoperative tramadol intake. The tramadol (+) group was more likely to receive pregabalin/mirogabalin or duloxetine. Tramadol (+) group showed worse neck pain, NDI, and EQ-5D scores preoperatively and worse NDI and EQ-5D 1 year postoperatively than tramadol (-) group. However, after propensity score matching, the improvement rate of the NRS for neck pain, and the minimal clinically important difference achievement for the NDI and EQ-5D were comparable between the 2 groups.

CONCLUSION

Patients receiving regular weak opioids preoperatively can achieve successful surgical outcomes after posterior decompression surgery for cervical spondylotic myelopathy.