ABSTRACT
Lumbar spine fusion is a major but common surgical procedure, which involves significant tissue dissection, with attendant blood loss and pain. Nonsteroidal anti-inflammatories must be stopped before surgery because of the antiplatelet activity which would increase the surgical bleeding, but the cyclooxygenase-II (COX-II)-specific inhibitors have reduced the gastrointestinal (GI) side effects and low antiplatelet activity (1,2) and further, they play an important role as a potential adjunct to other analgesics after surgery (3). A long convalescence follows, as bone healing is expected optimistically to occur in six to 12 months, and the bone fusion to mature after about two years. Following this major procedure is a prolonged convalescence, during which analgesics are required and chronic narcotic usage is common. Patients undergoing these procedures are often unable to work, deliberately stressed by the adversarial legal system, to either force them back to work expeditiously or to settle. Depression often occurs during the stress of the situation, and the depressing effect of narcotic drugs, and diminished self-image from loss of productivity. Many of these patients have unrelieved severe pain, motivating consideration of surgery and requiting significant doses of narcotics. The surgical procedure is scheduled after a sufficient duration to qualify as an exhaustion of conservation therapy, and often also delayed by insurance denials or litigation, resulting in some degree of tolerance and dependence on opioids before surgery. Inactivity during this disability and recovery may lead to weight gain, further prolonging of the subsequent rehabilitation to restore muscle tone and conditioning, and contribution to the possibility of developing a chronic dependence on opioids.
