Opioids and fusions

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pmrmd

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Animal models suggest opioids can inhibit bone fusion after spine surgery. I have a patient with multiple non-unions now, but I can't recall seeing this too often. I would think there are other reasons than opioids. Has anyone else seen failed fusion often and any idea why it occurred?

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Smoking, osteoporosis and chronic steroid use is my experience.
 
Right. I would think if opioids were a major cause we would see this all the time. This lady is a non-smoker, young, and hasn't had a ton of roids.

Any other causes for non-union?
 
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Young?

Thyroid, vitamin D, or maybe protein calorie malnutrition?

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Right. I would think if opioids were a major cause we would see this all the time. This lady is a non-smoker, young, and hasn't had a ton of roids.

Any other causes for non-union?

poor surgical technique? instrumented vs. non-instrumented?

is there a pseudoarthrosis?

in young healthy patient, it probably isnt the opioids. agree with the above
 
I would look at the bone density and check hormone/vitamin stuff. Is she anemic? What's her hair look like? Is it a surgical technique issue?

Generally the opioid issues are a higher MMEs and with chronic exposure. There is an acute direct effect in some preclinical studies, but I haven't seen any human data to suggest that's real.

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Patient of mine who was previously on chronic high dose opioids. Successfully weaned himself off before coming to me.

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