Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis

Abstract

Pierce D Nunley,1 Timothy R Deer,2 Ramsin M Benyamin,3 Peter S Staats,4 Jon E Block5 1Spine Institute of Louisiana, Shreveport, LA 71101, USA; 2Center for Pain Relief, Charleston, WV 25301, USA; 3Millennium Pain Center, Bloomington, IL 61704, USA; 4National Spine and Pain Centers, Rockville, MD 20852, USA; 5Jon Block, San Francisco, CA 94115, USA Background: Lumbar spinal stenosis (LSS) causes significant pain and functional impairment, and medical management has increasingly included the prescription of opioid-based analgesics. Interspinous process decompression (IPD) provides a minimally-invasive treatment option for LSS.Methods: 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.Results: At baseline, almost 50% (94 of 190) of subjects were using opioid medication. Thereafter, there was a sharp decrease in opioid-medication prevalence from 25.2% (41 of 163) at 12 months to 13.3% (20 of 150) at 24 months to 7.5% (8 of 107) at 60 months. Between baseline and 5 years, there was an 85% decrease in the proportion of subjects using opioids. A similar pattern was also observed among subjects with a history of opiates prior to entering the trial.Conclusion: Stand-alone IPD is associated with a marked decrease in the need for opioid medications to manage symptoms related to LSS. In light of the current opiate epidemic, such alternatives as IPD may provide effective pain relief in patients with LSS without the need for opioid therapy. Keywords: interspinous spacer, Superion, lumbar spinal stenosis, opioids, neurogenic claudication, indirect decompressio