Effect of Korean medicine treatment on surgery and opioid prescription among patients with lumbar spinal stenosis: a nationwide retrospective cohort study

TL;DR

This study finds that Korean medicine treatment may reduce the need for surgery and opioid use in patients with lumbar spinal stenosis.

Contribution

This is the first nationwide study to show that Korean medicine lowers surgery and opioid use in lumbar spinal stenosis patients.

Findings

Korean medicine treatment was linked to a 18% lower risk of lumbar surgery.

Patients using Korean medicine had a 19% lower risk of opioid use.

Excluding tramadol, Korean medicine users had a 24% lower risk of opioid use.

Abstract

Lumbar spinal stenosis (LSS) is a prevalent degenerative spinal condition in older adults, often necessitating surgical intervention and long-term pharmacological treatment. Korean medicine (KM) has emerged as a relatively safe alternative; however, its impact on surgical rates and opioid use in patients with LSS has not been thoroughly investigated. This nationwide retrospective cohort study aimed to assess the effects of KM treatment on these outcomes.

We analyzed claims data from the Health Insurance Review and Assessment Service (HIRA) for patients newly diagnosed with LSS in 2015. The KM group included patients who had ≥ 3 outpatient KM visits within 1 year of diagnosis and received KM care more frequently than Western medicine (WM). The control group comprised patients with ≥ 3 outpatient WM visits and no KM use during the same period. Propensity score matching (PSM) was performed, and outcomes were compared using Kaplan–Meier survival analysis and Cox proportional hazards models.

After PSM, 70,897 matched pairs were included in the surgery dataset, and 17,217 patients per group in the opioid dataset. KM treatment was associated with significantly lower risks of lumbar surgery (hazard ratio [HR]: 0.821; 95% confidence interval [CI]: 0.782–0.862), opioid use (HR: 0.810; 95% CI: 0.752–0.872), and opioid use excluding tramadol (HR: 0.76; 95% CI: 0.630–0.919).

These findings suggest that KM treatment is associated with a reduced long-term risk of lumbar surgery and opioid use in patients with LSS. KM may represent a potentially effective conservative treatment option. Further randomized controlled trials are warranted to validate these findings.

Figures