Pain medications are involved in more than 20 percent of deaths occurring in the years after spinal fusion surgery for low back pain, reports a study in the April 1 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

The risk of analgesic-related death is highest among patients with degenerative disc disease (DDD)—especially men aged 45 to 54, according to the new research, led by Dr. Sham Maghout Juratli of Wayne State University School of Medicine, Detroit.

Of 2,378 workers’ compensation patients who underwent spinal fusion surgery in Washington State between 1994 and 2001, 103 had died by 2004. The researchers analyzed the cause of death for each patient who died.

Analgesics Involved in 21 Percent of Deaths
The rate of death within three years after spinal fusion surgery was 1.9 percent. Deaths involving pain medications were the single most common category, accounting for 21 percent of all deaths. Of 22 analgesic-related deaths, 19 were accidental overdoses and three were suicides. Overall, nearly one percent of workers who underwent spinal fusion died of analgesic poisoning.

Although other diseases like cancer or heart disease combined to cause more deaths, analgesic-related deaths were the main cause of potential life-years lost. That’s because younger patients were more likely to die of analgesic poisoning, whereas older patients were more likely to die of other causes.

Workers whose back pain was primarily caused by DDD were at elevated risk of analgesic-related death—nearly three times higher than those with other diagnoses. The risk of death due to pain medications was highest among men aged 45 to 54 who had DDD—more than seven times higher than for other groups.

The risk of death in the first three months after spinal fusion surgery was 0.29 percent. This risk was highest for patients who were undergoing a second spinal fusion procedure.

The use of spinal fusion (also called lumbar fusion) is growing rapidly, despite a lack of agreement over which patients should undergo the procedure. This is of special concern because spinal fusion carries a higher risk of complications than other, less extensive surgical procedures. Although the initial risk of death is low, few studies have looked at the mortality rate beyond the first few months after spinal fusion.

The new results raise concern about the long-term risk of death after spinal fusion, especially deaths related to pain medications. The deaths reflect the high use of opioid (narcotic) analgesics by patients with back pain, despite the lack of strong evidence for their effectiveness.

“Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent spinal fusion than any other cause,” according to Dr. Juratli and colleagues. They believe that initial efforts to reduce analgesic-related deaths should focus on patients with DDD, especially men.

About Spine
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among general orthopaedic journals and subspecialty titles.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal, and regulatory sectors. Wolters Kluwer had 2008 annual revenues of €3.4 billion ($4.9 billion), employs approximately 20,000 people worldwide, and maintains operations in over 35 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices.

Source: Wolters Kluwer Health: Lippincott Williams & Wilkins