Spine 2026;51:1223–1232
Anterior cervical discectomy and fusion often relieves radicular or myelopathic symptoms, but medication use provides an additional real-world measure of recovery. This nationwide Finnish study links a spine registry with comprehensive outpatient prescription-purchase data. Around seven in ten preoperative users stopped repeatedly purchasing opioids or gabapentinoids after surgery, while new sustained strong-opioid use was uncommon. Nevertheless, approximately one in six patients continued repeated purchases during the first postoperative year. Preoperative medication exposure and modifiable factors such as smoking helped identify patients at risk.
Objective
To describe opioid and neuropathic-pain medication use after primary ACDF for degenerative cervical disease and identify independent predictors of repeated postoperative purchases.
Methods
The longitudinal study linked the nationwide FinSpine registry to Finland’s prescription database and included 4,366 consecutive patients operated between 2017 and 2022. Repeated postoperative use was defined as at least two purchases of the same drug class during months 2–12. New strong-opioid users had no strong-opioid purchase in the 6 months before surgery but met the repeated-purchase definition afterward. Multivariable logistic regression evaluated associated factors.
Main results
Before surgery, 41.9% purchased opioids and 41.2% gabapentinoids. During months 2–12 after ACDF, 16.5% made repeated opioid purchases and 15.6% made repeated gabapentinoid purchases. Among preoperative users, 69.5% stopped repeated opioid purchasing and 70.9% stopped repeated gabapentinoid purchasing.
Only 2.2% of previously strong-opioid-naïve patients became new repeated strong-opioid purchasers. Independent predictors of repeated postoperative purchases included pain lasting more than 1 year, smoking, greater baseline Neck Disability Index, central canal stenosis, unfavorable employment status and preoperative purchase of the same medication class.
Interpretation
Most previous users reduced sustained analgesic purchasing after ACDF, and surgery rarely initiated new repeated strong-opioid use. Yet persistent medication use in roughly one sixth of patients indicates that decompression and fusion do not address every contributor to pain, disability or pharmacological dependence. Dispensing is an objective outcome but is not synonymous with consumption or inappropriate use.
Limitations
Registry data cannot confirm whether purchased medication was taken, why it was prescribed or whether prescriptions related to cervical symptoms. Residual confounding from mental health, pain at other sites and prescriber behavior is possible. The Finnish healthcare and prescribing environment may limit international generalizability.
Clinical takeaway
Review opioid and gabapentinoid exposure before ACDF and set explicit postoperative deprescribing expectations. Patients who smoke, have symptoms exceeding 1 year, greater baseline disability or established medication use merit closer follow-up and coordinated pain management rather than automatic prescription renewal.
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