Spine surgeons, let’s talk about a post-op metric that doesn’t show up on your PACS (Picture Archiving and Communications System) but probably should: How many opioid pills your “opioid-naive” patients actually take after surgery.
Based on this prospective cohort study, the answer is often far fewer than you might think…and sometimes none at all.
In a cohort of 217 opioid-naive patients undergoing outpatient cervical and lumbar procedures, the authors tackled a simple but clinically powerful question: How much opioid is actually used after surgery, and does technique matter?
The answer? Oh, it matters.
Levels Matter: One vs…One More
Let’s start with something intuitive but important — levels count. Single-level cases averaged a modest 75 MME (morphine milligram equivalents), while multilevel procedures more than doubled that at 167 MME. Not exactly shocking, but it reinforces a key point: “just one more level” isn’t just a technical decision — it’s a pharmacologic one too.
Approach Matters More: Open vs Endoscopic Showdown
Among lumbar procedures, endoscopic surgery didn’t just perform better — it dominated. Patients undergoing endoscopic cases used only 48.6 MME on average, compared to 164.7 MME in open surgery.
That’s not a marginal gain — that’s a clinically meaningful drop that should make anyone rethink both surgical approach and discharge prescriptions.
The Zero-Opioid Phenomenon
Now for the mic-drop moment: 17.5% of patients used zero opioids postoperatively. None. Not a single pill.
Even more impressive? In single-level endoscopic cases, that number jumped to 36.3%. More than one in three patients walked away from spine surgery without touching opioids.
Spine surgery. No opioids.
Why This Is Happening
Minimally invasive techniques — particularly endoscopic and tubular approaches — likely reduce tissue trauma, inflammation, and postoperative pain. Less pain leads to less opioid use. Simple, logical, and increasingly supported by data.
Implications for Your Practice
If nearly one in five patients needs no opioids — and many more need far less than you prescribe — then your current prescribing habits may be a bit…enthusiastic.
This study makes a strong case for:
- Procedure-specific prescribing protocols
- Adjustments based on number of levels
- Greater emphasis on non-opioid analgesia
- Clearer patient counseling (“You may not even need these”)
The Take-Home Message
Not every case can be endoscopic, and not every patient will go opioid-free. But the trend is unmistakable: smaller surgical footprints are translating into smaller opioid requirements.
And maybe the most provocative takeaway of all? The best opioid prescription after spine surgery… might be the one you never write.
Origin Study Title: Opioid Use in Opioid Naive Patients After Minimally Invasive Spine Surgery
Authors: Dylan Moran, B.S.; Philip Zakko, M.D.; Jeremy Policht, M.D.; Kedar Roderick, B.S.; Daniel Park, M.D.