Spine (Phila Pa 1976). 2025 Aug 22. doi: 10.1097/BRS.0000000000005480. Online ahead of print.
ABSTRACT
STUDY DESIGN: A retrospective cohort analysis.
OBJECTIVE: This study investigates the association between initial postoperative gabapentinoid prescription and long-term opioid use following long-segment posterior lumbar instrumentation.
SUMMARY OF BACKGROUND DATA: Gabapentinoids have gained traction for their neuropathic pain-relieving properties and potential synergy with opioids. However, their long-term efficacy in minimizing postoperative opioid consumption remains uncertain, particularly in patients undergoing extensive spinal surgery.
METHODS: The TriNetX Research Network was queried to identify patients with preoperative diagnoses of lumbar spinal stenosis, spondylolisthesis or scoliosis who underwent posterior lumbar instrumentation spanning 3 to 12 vertebral segments. The study population was stratified by based on the extent of instrumentation, defined as either 3-6 or 7-12 spinal segments. These patients were further divided into two cohorts: those who were prescribed a gabapentinoid (gabapentin or pregabalin) within 30 days postoperatively and those who were not. To address potential confounders, 1:1 propensity score matching (PSM) was performed, adjusting for demographics, comorbidities, and preoperative prescriptions of opioids and gabapentinoids. Presence of select postoperative opioid prescriptions were assessed at 1 to 3 months, 3 to 6 months, 6 to 12 months, and 12 to 24 months.
RESULTS: A total of 28,827 patients met all initial inclusion criteria. Following 1:1 PSM, the 3-6 segment group included 1,816 patients per cohort and the 7-12 segment group consisted of 344 patients per cohort. Among 3-6 level instrumentations, patients who received gabapentinoids within 30 days of surgery demonstrated significantly lower odds of being prescribed non-codeine-based and strong opioids at all postoperative intervals. In contrast, these gabapentinoid-treated patients exhibited higher odds of weak opioid prescriptions at 3 to 6 months. No statistically significant difference in opioid prescribing was observed among 7-12 segment instrumentation patients at any period.
CONCLUSION: This study demonstrates that early postoperative gabapentinoid prescription is associated with a sustained reduction in chronic non-codeine-based and strong opioid use following 3-6 segment lumbar fusion. These findings underscore the utility of gabapentinoids as part of a multimodal analgesia strategy, potentially minimizing the need for more potent opioids and reducing the risk of long-term dependence in spine surgery patients.
PMID:40844769 | DOI:10.1097/BRS.0000000000005480
