Abstract
BACKGROUND: Although prior studies have laid the groundwork in establishing a better understanding of opioid use in spine trauma patients, additional clarity is needed on injury-specific factors that may predispose to higher or longer-term opioid use in this population. This study aims to identify clinical and neurological predictors-both modifiable and non-modifiable-of postoperative opioid utilization and weaning among patients undergoing surgery for traumatic spinal injuries. METHODS: A retrospective chart review was conducted of consecutive adults who underwent surgery for traumatic spine injuries between July 17, 2017, and May 21, 2021, identified by current procedural terminology (CPT) codes. Demographic data, perioperative factors [i.e., spinal cord injury (SCI) completeness, length of stay, follow-up duration, recovery status], and injury characteristics (i.e., dislocation, vertebral burst fracture, polytrauma) were extracted. Associations with morphine milligram equivalent (MME) at discharge and final follow-up were evaluated using bivariate analyses. Multivariable logistic regression was performed to identify independent predictors of opioid weaning. RESULTS: A total of 109 patients (average age 51.71±18.00 years, and average follow-up of 578.93±655.61 days) were studied. The proportion of patients using opioids decreased by 66.2% from discharge to final follow-up (89.4% to 23.2%). Average MME was 44.67±34.14 mg at discharge and was 7.86±19.33 mg at final follow-up (P=0.004). Higher MME use at discharge was significantly associated with incomplete SCI compared to complete (58.18 vs. 31.73 mg, P=0.006) and with partial motor and sensory recovery as compared to no recovery (59.30 vs. 31.54 mg, P=0.03). Multivariable logistic regression identified age [odds ratio (OR) =0.97, 95% confidence interval (CI): 0.94-0.99], cervical spinal injury (OR =4.96, 95% CI: 1.22-20.15), and complete SCI (OR =0.23, 95% CI: 0.07-0.75) as independent predictors of successful opioid weaning. Polytrauma, length of stay, and other injury characteristics were not significantly associated with MME use. CONCLUSIONS: Opioid use declines significantly over long-term follow-up in spinal trauma patients. However, individuals with incomplete spinal cord injuries and partial motor/sensory recovery remain at higher risk for prolonged use. In contrast, cervical-level injuries and older age were associated with successful weaning. These findings suggest that both neuropathic pain and traumatic nociceptive pain contribute to sustained opioid use and support the need for personalized, neurologically informed postoperative pain management strategies. Moreover, these findings also inform post-operative pain protocols by encouraging early stratification of opioid risk based on neurological injury patterns.