Minimally invasive spine surgeries reduce long-term opioid use

Kyphoplasty and vertebroplasty – two minimally invasive image-guided procedures to treat osteoporotic vertebral fractures – appear to be effective for decreasing long-term use of pain medication, according to a December 5 presentation at RSNA.

The finding provides new evidence on the effectiveness of the procedures, with recent studies showing conflicting outcomes, noted lead author Bassel Ibrahim, a medical student at the University of Texas Medical Branch in Galveston, and colleagues, in a scientific poster.

“There is controversy around the efficacy of these procedures, with much of the criticism aimed towards the inability of these procedures to manage pain long-term,” the group wrote.

Osteoporotic vertebral fractures (OVFs) are painful fractures in the spine that occur due to osteoporosis, with 750,000 people in the U.S. experiencing an OVF every year. Kyphoplasty and vertebroplasty are treatment options for patients in whom medication alone is not effective. These procedures repair OVFs through the injection of cement into fractured vertebra to stabilize them, the authors explained.

To address controversy over whether the procedures can help eliminate pain, the group analyzed the prevalence of opioid use in patients with OVF before and after undergoing the procedures.

The group analyzed electronic health records from 65 healthcare organizations across the U.S. between April 2014 and April 2024. They studied patient demographics at baseline and new persistent opioid medication use at one month before surgery and at one, three, six, and 12 months after surgery.

Among 209,314 patients identified with OVFs, 7,633 underwent kyphoplasty (KP) and 2,655 underwent vertebroplasty (VP). In the KP group, 94% of patients had new persistent opioid prescribing one month before the procedure. This number decreased to 17% at one month, 16% at three months, 17% at six months, and 13% at one year, the researchers reported.

In the VP group, 96% of patients had OVF-associated persistent opioid prescribing one month before the procedure. This number decreased to 19% at one month, 11% at three months, 19% at six months, and 13% at one year, they found.

“Following treatment, both KP and VP were associated with a reduction in opioid prescription fills,” the group wrote.

There was a statistical difference in opioid use between KP and VP at one month before the procedures (p = 0.0001) and at one month (p = 0.025) and three months (p = 0.045) after the procedures, the researchers added.

Ultimately, the study sheds new light on the effects of KP and VP on trends in opioid use. This information may be helpful in developing pain management strategies for patients.

“Understanding the effect of KP and VP procedures on trends in opioid use is crucial for long-term pain management strategies in patients with osteoporotic vertebral compression fractures,” the group concluded.