title: Preoperative opioid strength may not affect outcomes of anterior cervical procedures: a post hoc analysis of 2 prospective, randomized trials.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri;
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.affiliation: Department of Orthopedics & Rehabilitation, University of Wisconsin, Madison, Wisconsin; and.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
authors.affiliation: Department of Orthopedic Surgery, Indiana Spine Group, Indianapolis, Indiana.
authors.forename: Rick C
authors.initials: RC
authors.lastname: Sasso
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri;
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D011843:Radiculopathy / Q000601:surgery*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D011795:Surveys and Questionnaires; D059145:Total Disc Replacement / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: ACDF = anterior cervical discectomy and fusion; IDE = investigational device exemption; MCS = Mental Component Summary; NDI = Neck Disability Index; PCS = Physical Component Summary; SF-36 = 36-Item Short-Form Health Survey; TDA = total disc arthroplasty; cervical arthroplasty; cervical fusion; narcotic; opioid; pain