Middle-aged men with disk degeneration at highest risk

DETROIT- 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 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, assistant professor of family medicine in the School of Medicine, at Wayne State University.

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 Juratli and colleagues. They believe that initial efforts to reduce analgesic-related deaths should focus on patients with DDD, especially men.

To view the full article, visit www.spinejournal.com. 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.

Wayne State University is one of the nation's pre-eminent public research universities in an urban setting, ranking in the top 50 in R & D expenditures of all public universities by the National Science Foundation. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world.