New Study: Lumbar Decompression=Reduced Opioid Use

A new multicenter study has found that using interspinous process decompression (IPD) to treat painful lumbar spinal stenosis can reduce the need for opioid medications in patients.

The work, “Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis,” appears in the November 20, 2018 edition of the Journal of Pain Research.

Co-author Pierce D. Nunley, M.D. director of the Spine Institute of Louisiana in Shreveport, Louisiana, and associate professor in the Department of Orthopaedic Surgery at the Louisiana State University Health Sciences Center, explained the purpose of the study to OTW, “With the heightened awareness of the current opioid crisis it is important to evaluate all the ways we can have a positive impact.”

“It was obvious to me that surgery can decrease dependence on opioids and pain medications. With that thesis we looked at the data in the Superion trial to see if the procedure resulted in decrease usage of narcotics.

The authors wrote: “This study estimated the type, dosage, and duration of opioid medications through 5 years of follow-up after IPD with the Superion Indirect Decompression System (Vertiflex Inc., Carlsbad, CA USA). Data were obtained from the Superion-treatment arm of a randomized controlled noninferiority trial. The prevalence of subjects using opiates was determined at baseline through 60 months. Primary analysis included all 190 patients randomized to receive the Superion device. In a subgroup of 98 subjects, we determined opioid-medication prevalence among subjects with a history of opioid use.”

Dr. Nunley commented to OTW, “The data analysis demonstrated that the use of Superion in this study did result in a decrease of opioid usage. The interesting point of this study is this was a retrospective review of a prospective Level I study conducted and completed well before the awareness of the opioid crisis.”

“Most surgeons do not know about Superion and IPD because of the history of varied results. It takes time to get the data out there and for surgeons to become aware of the technology. There have also been some coding and reimbursement issues that have largely been solved that surgeons are not aware. Availability for ASCs [ambulatory surgery centers] may prove to be a pathway to greater awareness.”

“The first practical recommendation from this work is we need to start thinking about surgery as a benefit to patients in their quality of life and particularly the positive impact surgery can have on combating the opioid crisis. More specifically, in the present study, the Superion procedure has demonstrated decrease utilization of opioids in this study population.”