Opioid Use in Opioid Naive Patients After Minimally Invasive Spine Surgery

Study Design Prospective cohort study. Objectives To evaluate postoperative opioid use in opioid-naive patients undergoing lumbar or cervical spine surgery and assess the impact of surgical approach (open vs minimally invasive) and number of operative levels on opioid consumption. Methods A prospective cohort of 217 opioid-naive patients undergoing outpatient spine surgery from August 2023 to December 2024 was analyzed. Patients were stratified by surgical approach (open, tubular, endoscopic) and by single-vs multilevel procedures. Opioid usage was measured in total morphine milligram equivalents (MME) based on patient-reported pill counts at 2 weeks and follow-up interviews at 3 months. Results Patients undergoing single-level procedures used significantly fewer opioids than those undergoing multilevel procedures (75.1 ± 97.0 MME vs 167.3 ± 239.6 MME; P = .0068). Among lumbar surgeries, endoscopic procedures had the lowest average opioid use (48.6 ± 57.8 MME), significantly less than open procedures (164.7 ± 223.7 MME; P = .0021). Overall, 17.5% of patients required no postoperative opioids, with the highest rate seen in the single-level endoscopic group (36.3%). Conclusion Minimally invasive spine surgery techniques, particularly endoscopic and tubular approaches, were associated with reduced postoperative opioid use and fewer refill requests compared to open procedures within this heterogeneous cohort of lumbar and cervical procedures. Multilevel surgeries were associated with higher opioid consumption. These findings support the development of tailored opioid prescribing protocols for opioid-naive patients, potentially reducing overprescription and improving pain management. Patient education on non-opioid analgesia and standardized prescribing guidelines may further reduce opioid reliance after spine surgery.