BACKGROUND CONTEXT
Evaluation of 10-year clinical safety and effectiveness of cervical disc arthroplasty (CDA) using the Prestige LP™ disc to treat degenerative cervical spine disease at two adjacent levels has been completed and published. One of the contributing factors to the current opioid crisis in the U. is increased opioid prescription for back and neck pain. Better surgical outcomes may lead to less use of pain medications for CDA patients.
METHODS
Data were obtained during the FDA-approved clinical trial, and although not considered as safety or efficacy outcomes for the trial, data were later analyzed for the current study. At preoperative and all postoperative visits up to 10 years, subjects were asked how often during the last week they used pain medications. Pain medication use was statistically compared between CDA and control group ACDF patients at 6 weeks, 3 and 6 months, and 1, 2, 3, 5, 7, and 10 years postoperatively.
RESULTS
Prevalence of preoperative use of narcotic medications once or more a day was not significantly different between the treatment groups (47.8% for CDA and 44.4% for ACDF). Prevalence decreased substantially for both groups after surgery, but was significantly lower for CDA than ACDF (p<0.050) at all postoperative time points, except 1 year (p=0.051) and 10 years (p=0.069) which also trended lower. A repeated measure analysis showed that the overall postoperative difference in narcotic medication usage over time up to 10 years was significantly different between the CDA and ACDF groups (p=0.003).
CONCLUSIONS
The percentage of subjects who used opioid medications once or more a day after receiving the Prestige LP CDA was statistically lower than that in the ACDF group overall and at most postoperative time points. The greater clinical outcome improvements shown in the clinical trial may have led to less use of narcotic medications for CDA patients. For future studies, the use of narcotics after surgery might be considered as a treatment outcome in addition to patient-reported functional and pain outcomes.
