Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Global Spine Journal

Abstract

Introduction: Though often necessary for adequate analgesia after spine surgery, continued opioid use can lead to chronic dependency. The Michigan Spine Surgery Improvement Collaborative (MSSIC) has demonstrated in prior work the promise of utilizing a multi-institutional morphine milliequivalent (MME) cutoff for elective anterior cervical surgery in the opioid naıve population. However, the effect of this cutoff in patients who were already on opioids pre-operatively have not previously been studied. The goal of this study was to evaluate whether changes in prescribing patterns in the opioid naıve population would also translate to the non-naıve populations, and whether the non-naıve population would also see improved outcomes if prescribed within a certain threshold. Material and Methods: The MSSIC database was queried from January 2022 to December 2024 for patients across 29 hospitals and ASCs who underwent 1-2 level anterior cervical surgery and had a pre-operative history of opioid use. Patients were grouped based on compliance with the MSSIC morphine milliequivalent (MME) cutoff for the cervical spine: MME ≤ 225 (averaged over 7 days). Outcomes analyzed included continued opioid use, post-operative complications, and patient reported outcomes (PROs) such as pain and functional scores at 90-days and 1-year. A multivariate analysis was conducted to control for confounders. Results: 6,401 patients were included in this analysis. At baseline prior to the study, 44% of opioid non-naıve patients were prescribed 225 MME or less, compared to 65% starting 2022. Opioid non-naıve patients who were compliant with the MME cutoff were less likely to have continued opioid use at 90 days compared to opioid non-naıve patients who were not MME cutoff compliant (OR 0.70; CI 0.55-0.88, p = 0.001). There was no significant difference in complications, ED visits, readmission, or achieving minimal clinically important difference (MCID) in neck or arm pain. Conclusion: Implementation of a multi-institutional opioid cutoff is well tolerated and demonstrated the potential to reduce continued long-term opioid use. Based on prescribing behaviors for opioid naıve patients, opioid non-naıve patients also observed some benefit with fewer opiates prescribed overall. Importantly, this was achieved without an increase in adverse events or worsened PROs related to inadequate analgesia.

Volume

16

Issue

2 Suppl

First Page

S317

Comments

Global Spine Congress, May 27-30, 2026, Istanbul, Turkey

Last Page

S318

DOI

10.1177/21925682261435810

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