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Sharma et al.
of postoperative care. At present, there is no clear consensus
regarding pharmacological management of postoperative
pain during hospital stay. Postoperative pain management
largely depends on patient's factors (ie, history of medication
use, comorbidities, etc), surgery type, and physician's practice pattern. Although multimodal analgesic approach is
gaining momentum,30 opioids are still considered gold standard to manage postoperative pain.12,31,32 Our results are in
agreement with these observations and suggest that patients
following LSS are mostly treated with opioids alone (53.4%;
1663 of 3115), followed by opioid in conjunction with other
medications (41.5%; 1292 of 3115), regardless of lumbar
surgery type or age categories. We also observed that medication usage increased as patient ages.
Specifically for older population, evidence is lacking to
recommend appropriate opioid use or when its risks outweigh its benefits for postoperative management. However,
in this study, 8% differences identified (Table 3: 28.7% vs.
36.8%) in use of opioid alone compared with opioid combined with other pain medications may illustrate a lack of
comfort or increased concern in using opioids in older populations. Further robust study is needed to determine medication impact on surgical outcomes in larger diversified
population. Current study results can be used to gain a better
understanding of LSS patterns and analgesic medication
usage across various age groups and the gap in knowledge
currently filled by this study can help in the design of future
studies.
The study highlights an increased trend in laminectomy
among older adults and use of opioid medications. This
knowledge can help health care providers better plan patient
care and rehabilitation services for older adults, as the trajectory of LSS is likely to rise with growing prevalence of older
adults. The information regarding increased opioid utilization may also help clinicians refine opioid usage and consider alternative approaches to manage acute postoperative
pain, in light of the current concerns related to overutilization of opioids.

patients' employment, as well as insurance coverage would
have provided a more comprehensive report of the population
type seeking LSS procedures. However, the strength of our
study was that we included a general trend in use of medication for postoperative pain management using observational
data. We could not follow these patients to collect post-hospital
outcomes, and we could not view whether these patients went
home with these medications. A critical area for future
research should address how to reverse the current trend of
opioid crisis, including opioid overdose and opioid use disorder, which has engulfed our nation.33,34 Our results, although
limited to one institute, address the gap in current knowledge
and provide timely information about pattern of LSS in various age groups.

Limitations

Funding

The results from this study represent only one hospital's surgical outcomes, and thus, findings cannot be generalized;
however, the KU hospital is located in a large metropolitan
city and patients from nearby regions seek expertise of spine
surgeons. Thus, our results may be representative of surgical
practice within the Midwest region. Changes in insurance
coverage may also influence the choice of LSS performed.
Second, the patient population reported is mostly white
(84.9%) and non-Hispanic (96.9%). This result may not represent population of other ethnicity or race. However, patient
demographics are generally not by choice as spine surgeries
are considered elective procedures and largely dependent on
surgeons' and patients' choice as well as geographical location. Finally, other important data such as pain variables,

The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
work was supported by a CTSA grant from NCATS awarded to the
University of Kansas Medical Center for Frontiers: The Heartland
Institute for Clinical and Translational Research # UL1TR000001
(formerly #UL1RR033179).

Conclusion
In summary, we observed an increase in LSS procedures
between 2007 and 2014, nearly a 2-fold increase in LSS in
older adults. In addition, this study reports a rise in LSS with
age. Specifically, laminectomy procedures are more common in older population, whereas discectomy procedure is
more common in the younger population. Use of opioids
alone followed by opioids in combination with other analgesics is more prevalent in all age groups. Larger study samples
representing national data are needed to further understand
the rising trend in LSSs and associated pain characters, and
medication usage.
Authors' Note
Dr. Olotu was a a postdoctoral fellow under the supervision of
Dr. Rasu at the time of the study at University of Kansas. Mrs. Mathew
was a Modale Fellow of University of Kansas Medical Center at the
time of the study under the supervision of Dr. Sharma.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

References
1. Walker BF. The prevalence of low back pain: a systematic
review of the literature from 1966 to 1998. J Spinal Disord.
2000;13(3):205-217.
2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries
1990-2010: a systematic analysis for the Global Burden of
Disease Study 2010. Lancet. 2012;380(9859):2163-2196.

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