Return to work rate and long-term effectiveness of delayed versus early surgery for back pain and sciatica in Russian Railways employees: a single-center retrospective study.

Objective To observe the mid-and long-term clinical efficacy of minimally invasive transforaminal lumbar interbody fusion for the treatment of single-segment lumbar degenerative diseases. Methods Retrospective analysis of the clinical data of 832 patients with lumbar degenerative disease treated with single-segment MIS-TLIF surgery from 2007 to 2013, 443 males and 389 females; aged 23-82 years, mean 56.4±18.7 years old. All cases were divided into revision surgery group, severe lumbar spinal stenosis group, moderate to severe lumbar spondylolisthesis group and general case groups (as a control) for comparative analysis. Efficacy evaluation indicators include Oswestry disability index (ODI), visual analog scale (VAS), intervertebral fusion rate, and complications. Results All patients were followed up for 62 to 93 months, with an average of 79.2±18.6 months. One month after operation, the VAS score of low back pain in the severe spinal stenosis group 2.9±0.5 and the moderate to severe spondylolisthesis group 3.8±1.1 were both significantly higher than the general case group 1.6±0.6, and the difference was statistically significant. The VAS score of leg pain was high in the moderate to severe slip group 2.6±0.7, but the difference was not statistically significant. The ODI value was significantly higher in the moderate to severe spoiler group 28.8±6.9% than in the general case group 22.1±6.4%. In the 2 years after the operation, the vas of lower back pain was divided into 2.4±0.9, compared with the general case group 1.7±0.5, and the difference was statistically significant; the ODI group of severe spinal stenosis and moderate-severe spondylolisthesis were 17.9%±3.4% and 19.4%±4.9%, respectively, which was higher than the general case group 11.3%±3.3%, and the difference was statistically significant. In the last follow-up, the VAS scores 2.3±0.8 and 2.6±1.1 of the severe vertebral canal stenosis group and the moderate-severe spondylolisthesis group were respectively higher than that of the general case group 1.6±0.7, and the difference was statistically significant; the ODI group of severe vertebral canal stenosis and moderate-severe spondylolisthesis were 18.3%±11.1% and 19.6%±12.1, higher than the general case group 11.8%±9.7%, the difference was statistically significant. The incidence of mid- and long-term complications (intervertebral non-fusion, adjacent segment disease) was not statistically significant among the four groups. Conclusion MIS-TLIF treatment of lumbar degenerative diseases can obtain good medium and long-term clinically effect. For complex diseases such as revision, severe degeneration and moderate to severe spondylolisthesis, MIS-TLIF did not increase the incidence of medium and long-term complications. Key words: Lumbar vertebrae; Surgical procedures, minimally invasive; Spinal fusion

INTRODUCTION: The Oswestry Disability Index (ODI), SRS-22, and SF-12 demonstrate improvement of adult scoliosis patients after surgical treatment. None of these measures specifically addresses leg pain, the presence of which is an independent predictor of a patient's choice for operative care. The purpose of this study was to assess whether improvement in leg pain after surgery is correlated with improvements in standardized outcome measures, independent of improvement in back pain. METHODS: This study is a retrospective review of a prospective multicenter database of adults with spinal deformity. At the time of enrollment and follow-up, patients complete the ODI, SRS-22, and SF-12, as well as assessment of leg and back pain (visual analog score [VAS]). Multiple linear regression analyses were used to assess for correlation between changes in back and leg pain and changes in ODI, SRS-22, and SF-12 at 2 years after surgery. RESULTS: 101 surgically-treated adult scoliosis patients with both baseline back and leg pain (VAS > 0) were included. Two years after surgery, all mean measures of outcome assessed significantly improved, including ODI (41–24, P < 0.001), SRS-22 (2.8–3.7, P < 0.0001), SF-12 PCS (physical component score, 30–40, P < 0.0001), SF-12 MCS (mental component score, 50–53, P = 0.04), VAS for back pain (6.9–2.8, P < 0.0001), and VAS for leg pain (5.4–2.1, P < 0.0001). Improvements in both back and leg pain were significantly and independently correlated with improvement in ODI (leg pain: B = 1.43, P = 0.001; back pain: B = 1.80, P < 0.001; R = 0.59) and SRS-22 (leg pain: B = −0.058, P = 0.004; back pain: B = −0.071, P = 0.002; R = 0.28). Only change in back pain VAS correlated with change in SF-12 PCS (B = −2.12, P < 0.001; R = 0.49), and only change in leg pain VAS correlated with change in SF-12 MCS (B = −1.44, P = 0.001; R = 0.37). CONCLUSION: Improvement in leg pain after surgery is correlated with improvement in standardized measures of health status and disability, independent of improvement in back pain. These findings emphasize the importance of recognizing and addressing leg pain in adults with scoliosis when contemplating surgical treatment.

Objective To investigate the short-term clinical effect and safety of extreme lateral interbody fusion (XLIF) for the treatment of lumbar degenerative diseases.Methods Sixteen patients (6 males and 10 females) with an average age of 62 (36 to 82) years were included,consisting of lumbar spinal instability in 9 cases and lumbar spinal stenosis in 7 cases.All patients had undergone XLIF procedure with posterior percutaneous pedicle screw fixation from September 2009 to January 2013.The fusion level was one in 11 cases,two in 4 cases,and three in 1 case.The visual analogue scale (VAS),Oswestry disability index (ODI) and Macnab criteria were used to assess the clinical effect postoperatively while X-ray and CT were used to evaluate the fusion.The operation time,blood loss and postoperative complications were also analyzed.Results Mean operation time and blood loss for discectomy and interbody placement was 75 min and 83 ml per level.We found transient thigh numbness and weakness of hip flexor in 2 cases,which resumed automatically within 2 weeks.All patients were followed up for an average of 15 (6 to 48) months.The VAS score was 4.6 and 3.1 lower in back pain and leg pain while ODI score was 50％ lower in six months postoperatively.According to the Macnab criteria,the excellent and good rate was 87.5％.There were 4 complete fusion cases and 11 partial fusion cases in 6 months.7 cases out of 8 achieved complete fusion while 1 case achieved partial fusion after 12 months.The fusion rate was 87.5％.Conclusion XLIF can provide a satisfactory short-term outcome for the treatment of lumbar degenerative diseases. Key words: Spinal fusion; Lumbar vertebrae; Intervertebral disc degeneration

Objective To evaluate the early clinical outcomes and complications of oblique lateral interbody fusion (OLIF) in the treatment of degenerative lumbar diseases. Methods All of 83 patients, 29 males and 54 females with ages from 32 to 83 (average 60.8±13.7 y), underwent OLIF with or without posterior pedicle screw-rod instrumentations from October 2014 to February 2017. The index diagnosis was discogenic back pain in 17 cases, spondylolisthesis in 23, lumbar spinal canal stenosis in 25, and degenerative lumbar spinal kyphoscoliosis in 18 cases. The distribution of operative level was 5 at L1,2, 13 at L2,3, 38 at L3,4, and 69 at L4,5. The mean number of fusion level for each case was 1.5 segments. The operative duration, blood loss during operation, intra-operative and post-operative complications, the length of post-operative hospital stay were recorded. Clinical outcomes were evaluated using visual analogue scale (VAS) and Oswestry disability index (ODI). All patients were followed up for at least 3 months. Lumbar X-ray and CT scans were taken and the clinical outcomes were re-assessed during follow-up. Results Fifty-one in the 83 patients underwent supplementary posterior pedicle screw-rod instrumentation with OLIF procedures. The operation lasted for 43-295 min, with a mean duration of (153 ± 72) min. Mean operation time for each OLIF segment was 43±12 min. Blood loss during the operation was 30-800 ml, with a mean of 125±74 ml. Mean blood loss for each OLIF segment was 27±13 min. Average length of stay was 5.6 ± 3.2 d, ranging from 3-15 d. The VAS for back pain and leg pain and ODI scores were decreased apparently for each patient. The total incidence of complications was 22.9% (19/83), including 6.0% (5/83) of intra-operative complications (4 cases of cage subsidence, 1 case of segmental artery injury) and 16.9% (14/83) of post-operative ones. The latter consisted of ipsilateral hip flexor weakness in 6, ipsilateral anterolateral thigh pain in 2, ipsilateral lateral thigh numbness in 1, contralateral pain in flexion of hip in 1, ipsilateral sympathetic chain injury in 2, and pain in area of iliac bone donor site in 2. All symptoms were released or disappeared during follow-up. Conclusion OLIF as a novel minimally invasive technique can act as a safe and effective treatment for degenerative lumbar diseases, which can also reduce approach-related complications. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Spondylolisthesis; Spinal stenosis; Scoliosis; Kyphosis; Spinal fusion; Intraoperative complications; Postoperative complications

A total of 41 patients who had undergone percutaneous nucleotomy for a single level lumbar disc herniation were clinically examined after a mean postoperative follow-up of 5 years (range 4 to 7 years). There were 14 (34%) male and 27 (66%) female patients with a mean age of 49 years. By intra-operative discography, the herniation had been graded as a protrusion in 21 (51%) patients and as a prolapse in 20 (49%) patients. At the time of the investigation, sciatica had completely recovered or markedly diminished in 32 (78%) patients, and 29 (71%) patients had returned to work. Evaluated by a 100 mm visual analog pain scale (VAS), the postoperative pain relief was statistically significant (p < 0.0001). Clinical signs and symptoms of segmental instability of the lumbar spine were detected in 10 (24%) patients. Instability was significantly associated with an unsatisfactory long-term outcome in the patients with the occurrence of sciatica (p = 0.003) and low back pain (p = 0.001) as well as the VAS score (p = 0.005) and Oswestry index (p < 0.0001). Clinical investigation revealed sensory deficits in the leg in 12 (29%) patients, weakness of the extensor hallucis longus muscle in 5 (12%) patients and a total peroneal paresis in one (2%). The patellar and achilles tendon reflexes were depressed in 2 (5%) and 5 (12%) patients, respectively. During the follow-up period, recurrent disc herniation was detected in 3 (7%) patients who were all re-operated on. In addition, 3 (7%) patients were re-operated on for other back problems. Corroborating earlier findings, the results of this study indicate that percutaneous nucleotomy is an effective and safe alternative to open surgery in the treatment of patients with a small prolapse or a protrusion.

Objective To analyze the clinical efficacy of posterior decompression and dynamic neutralization system (Dynesys) for treatment of lumbar degenerative disease. Methods A total of 97 patients with lumbar degenerative diseases, who underwent posterior spinal decompression and Dynesys fixation of vertebral pedicle between May 2011 and September 2013 were included in the study, including 54 males and 43 females (aged 29 to 56 years old, median age 38 years old; 63 cases of single segment, 34 cases of double segments, Using Oswestry disability index (ODI) , visual analogue scale (VAS) and Japan Orthopaedic Society (JOA) scoring to evaluate the clinical efficacy. According to the imaging data of the preoperative and the last follow-up, the changes of the intervertebral height of surgical segments, vertebral range of motion (ROM) of surgical and adjacent segments, and intervertebral disc degeneration were determined. The intervertebral angles of anterior-posterior lateral and dynamic lumbar X-ray were measured, and the ROM of the intervertebral angles was calculated. The average calibrated disc signal (CDS) of surgical segments was calculated by lumbar magnetic resonance imaging (MRI). The repaired condition of intervertebral disc was evaluated. Results The length of follow-up was 24 to 52 months, and the median length of follow -up was (31.21 ± 7.63) months. There were no serious complications and recurrence of repaired cases. Low back pain was aggravated in 3 patients at 3 months after the operation, and was relieved after conservative treatment. The VAS score and ODI of the last follow -up after the operation were significantly reduced than those before the operation (P 0.05). Fifty-three patients received lumbar MRI reexamination at the last preoperative follow-up [mean age (37.83±11.56) years old, a total of 66 segments], and the average CDS of surgical segments was improved from 39.51%±10.76% to 47.35%±13.61% (P<0.01). Conclusion The length of follow-up was 24 to 52 months, and the median length of follow-up was (31.21±7.63) months. There were no serious complications and recurrence of repaired cases. Low back pain was aggravated in 3 patients at 3 months after the operation, and was relieved after conservative treatment. The VAS score and ODI of the last follow-up after the operation were significantly reduced than those before the operation (P 0.05). Fifty-three patients received lumbar MRI reexamination at the last preoperative follow-up [mean age (37.83±11.56) years old, a total of 66 segments] , and the average CDS of surgical segments was improved from 39.51%±10.76% to 47.35%±13.61% (P<0.01). Key words: Lumbar vertebrae; Intervertebral disc; Treatment outcome; Dynamic neutralization system

Background Transforaminal lumbar interbody fusion (TLIF) through a minimally invasive approach (mTLIF) was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF (oTLIF), but inconsistent outcomes were reported. Methods We conducted a meta-analysis to evaluate the effectiveness of mTLIF and oTLIF in the treatment of degenerative lumbar disease. We searched PubMed, Embase and Cochrane Database of Systematic Reviews in March 2013 for studies directly comparing mTLIF and oTLIF. Patient characteristics, interventions, surgical-related messages, early recovery parameters, long-term clinical outcomes, and complications were extracted and relevant results were pooled. Results Twelve cohort studies with a total of 830 patients were identified. No significant difference regarding average operating time was observed when comparing mTLIF group with oTLIF group (-0.35 minute, 95% confidence interval (CI): -20.82 to 20.13 minutes). Intraoperative blood loss (-232.91 ml, 95% CI: -322.48 to -143.33 ml) and postoperative drainage (-111.24.ml, 95% CI: -177.43 to -45.05 ml) were significantly lower in the mTLIF group. A shorter hospital stay by about two days was observed in patients who underwent mTLIF (-2.11 days, 95% CI: -2.76 to -1.45 days). With regard to long-term clinical outcomes, no significant difference in visual analog scale score (-0.25, 95% CI: -0.63 to 0.13) was observed; however, there was a slight improvement in Oswestry Disability Index (-1.42, 95% CI: -2.79 to -0.04) during a minimum of 1-year follow-up between the two groups. The incidence of complications did not differ significantly between the procedures (RR=1.06, 95% CI: 0.7 to 1.59). Reoperation was more common in patients in mTLIF group than in oTLIF group (5% vs. 2.9%), but this difference was not significant (RR=1.62, 95% CI: 0.75 to 3.51). Conclusion Current evidence suggests that, compared with traditional open surgery, mTLIF reduces blood loss and allows early postoperative recovery, while achieving comparable or slightly better long-term outcomes, and with a comparable risk of complications.

Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion(TLIF)and posterolateral fusion(PLF)procedures in which unilateral pedicle screw fixation was used.Methods From December 2006 to August 2008,78 cases with the lumbar degenerative diseases who received lumbar posterolateral fusion were analyzed.There were 48 cases of which underwent TLIF and PLF procedures with unilateral pedicle screw fixation(unilateral group),including 25 males and 23 females with an average of 47.6 years;and 30 cases of which underwent TLIF and PLF procedures with bilateral pedicle screw fixation(bilateral group),including 21 males and 9 females with an average of 50.5 years.The clinical effects between the two groups were evaluated with Oswestry disability index and visual analogue score(VAS)index.The operation time,blood loss,fusion rates and intervertebral collapse rates were also compared.Results Oswestry disability index,low back pain VAS index and skelalgia VAS index in both groups showed statistical significance between preoperation and 3 months,or 3 months and 1 year postoperatively.There was no difference in score improvement between the two groups.There were difference in operation time,blood loss and cost of hospitalization between unilateral and bilateral group.The former was lower.There was no difference in postoperative length of stay between the two groups.The fusion rate of unilateral group and bilateral group were 91.7%(44/48)and 93.3%(28/30),respectively.Conclusion Auto graft combined with unilateral pedicle screw fixation provids better spinal instant stability.TLIF and PLF with unilateral pedicle screw fixation was a satisfactory method in treating degenerative disease of lumbar vertebrae. Key words: Lumbar vertebrae; Spinal fusion; Spondylarthropathies

The purpose of this study was to evaluate factors that correlated with unsatisfactory short- and long-term outcome in patients who sustained unstable pelvic ring fracture. The study subjects of this study were those of type B and C pelvic ring fractures (82 patients; mean age 54 years). Age, gender, associated injuries, fracture type, Injury Severity Score rating and treatment methods were assessed, and Majeed score for functional outcome and radiographic studies at 1 year after injury (short-term) and at final follow-up (long-term), with mean follow-up of 98 months were analyzed. Significant univariate factors ( p < 0.05) were entered in a multivariate logistic regression model to determine the independent predictors of unsatisfactory functional outcome. Univariate analysis showed that fractures of the lower extremity, nerve damage, conservative treatment, and radiological outcome correlated with unsatisfactory short-term functional outcome, while female gender, brain injury, nerve damage, conservative treatment, fracture location at the posterior portion of pelvic ring, radiological outcome, and pure sacroiliac dislocation only for type C fracture correlated with unsatisfactory long-term outcome. Multiple logistic regression analysis identified fractures of the lower extremity (odds ratio (OR): 5.364), conservative treatment (OR: 13.690), and nerve damage (OR: 21.392) as determinants of unsatisfactory short-term functional outcome and nerve damage (OR: 66.926) and poor radiological results (OR: 33.944) as determinant of long-term functional outcome. In patients with unstable pelvic ring injury, fractures of the lower extremity, conservative therapy, and nerve damage influenced short-term functional outcome, while that nerve damage and the pelvic ring displacement over 20 mm negatively affected long-term outcome.

To evaluate the clinical outcomes of Biofelx dynamic stabilization system in the treatment of lumbar degenerative disease (LDD). A total of 29 patients (16 males, 13 females) received the treatment of Bioflex between June 2011 and April 2013 were recruited. There were with lumbar spinal stenosis (n = 15), lumbar disc herniation (n = 10) and lumbar spondylolisthesis (n = 4). And they underwent one-segment (n = 14), two-segment (n = 10), three-segment (n = 3) and four-segment (n = 2) implantations. Mean age was 52.3 (38-62) years. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical outcomes. And lumbar radiography was used to observe disc height (DH) and range of motion (ROM) in fixed segment and cranial adjacent segment before and after operation. The mean follow-up period was 22.6 ± 2.1 (8-32) months. The mean ODI score decreased from 39.96 ± 2.58 preoperatively to 11.26 ± 1.76 at 3 months postoperatively (P < 0.05) and 3.97 ± 1.30 at the last follow-up (P < 0.05). The mean VAS score for low back pain dropped from 7.34 ± 0.80 preoperatively to 2.63 ± 1.01 at 3 months postoperatively (P < 0.05) and 0.91 ± 0.32 at the last follow-up (P < 0.05). The mean VAS score for leg pain deceased from 8.63 ± 0.95 preoperatively to 2.13 ± 0.62 at 3 months postoperatively and 0.58 ± 0.65 at the last follow-up (P < 0.05). The implanted segment preserved some ROM at the last follow-up. Compared to preoperative, no statistically significance existed in postoperative DH and ROM (P > 0.05). The clinical outcomes of Bioflex system are excellent in the treatment of LDD. As an effective therapy for non-fusion of LDD, it may preserve some ROM of fixed segment and prevent increased range of motion in adjacent segment.

Objective To investigate clinical efficacy of dynamic interspinous assisted motion(D1-AM)system in treatment of degenerative lumbar disease.Methods Eight cases with lumbar vertebral insta-bility were treated with the DIAM system at Peking Union Medical College Hospital from June 2006 to Jan-uary 2008.There were 6 female and 2 male cases,with a mean age of 46.9 years ranging from 40 to 52years.Radiographs and scores on outcome measures including the visual analogue scale(VAS)for pain and Oswestry Disability Index(ODI)were recorded before surgery and at 3-month,6-month,1-year intervals and final follow-up after surgery.Results The follow-up time ranged from 12 to 31 months,with the mean of20.6 months.The ODI scores before surgery and at 3-month,6-month,1-year intervals and final follow-up af-ter surgery were 67.75±12.12,22.25±15.76,19.75±17.12,20.00±18.48 and 23.00±19.09,while VAS seores were 8.44±1.35,2.88±3.41,2.63±3.51,2.50±3.78 and 3.50±4.15,respectively.There were significant differ-ence between preoperative ODI and VAS scores and postoperative ones(P＜0.05); however no difference was found at the different postoperative follow-up time(P＞0.05).The L4,5 segment activity were 10.38°±5.13°,4.25°±2.19°,2.63°±0.92°,2.00°±0.86°and 2.13°±1.55°,respectively.There were significant difference be-tween preoperative L4,5 segment activity and postoperative ones(P＜0.05); however no difference was found at the different postoperative follow-up time(P＞0.05).The ODI and VAS score improvements were directly cor-related with segment activity(r＞0.7,P＜0.05).Conclusion The DIAM system appears to be a useful and ef-fective alternative in the surgical management of degenerative lumbar disease if the patients are correctly selected.However long-term follow-up is needed to evaluate clinical outcomes of the device. Key words: Lumbar vertebrae; Low back pain; Prostheses and implants; Treatment outcome

Few studies have quantified clinical improvement following minimally invasive lumbar decompression based on predominant back pain or leg pain. To quantify improvement in patient-reported outcomes following minimally invasive lumbar decompression and determine the degree of improvement in back pain, leg pain, and disability in patients who present with predominant back pain or predominant leg pain. Patients who underwent primary, one-level minimally invasive lumbar decompression for degenerative pathology were retrospectively reviewed. Comparisons of visual analog scale (VAS) back and leg pain scores, Oswestry Disability Index (ODI) scores, and Short Form-12 (SF-12) mental and physical component scores from pre-operative to 6-week, 12-week, 6-month, and 1-year follow-up. Subgroup analyses were performed for patients with predominant back pain or predominant leg pain. A total of 102 patients were identified. Scores on VAS back and leg pain, ODI, and SF-12 physical component improved from pre-operative to all post-operative time points. After 1year, patients reported a 2.8-point (47%) reduction in back pain and a 4-point (61.1%) reduction in leg pain scores; 52 patients with predominant back pain and 50 patients with predominant leg pain reported reductions in pain throughout the year following surgery. In both the back and leg pain cohorts, patients experienced reductions in ODI during the first 6months and throughout 1-year follow-up, respectively. The majority of patients achieved minimum clinically important difference, regardless of predominant symptom. Patients reported improvements in back and leg pain following minimally invasive lumbar decompression regardless of predominant presenting symptom; however, patients with predominant leg pain may experience greater improvement than those with predominant back pain.

The surgical procedures used for arthrodesis in the lumbar spine for degenerative lumbar diseases remain controversial. This systematic review aims to assess and compare clinical outcomes along with the complications and fusion of each technique (minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or minimally invasive lateral lumbar interbody fusion (MIS LLIF)) for treatment of degenerative lumbar diseases. Relevant studies were identified from Medline and Scopus from inception to July 19, 2016 that reported Oswestry Disability Index (ODI), back and leg pain visual analog score (VAS), postoperative complications, and fusion of either technique. Fifty-eight studies were included for the analysis of MIS-TLIF; 40 studies were included for analysis of LLIF, and 1 randomized controlled trial (RCT) study was included for comparison of MIS-TLIF to LLIF. Overall, there were 9506 patients (5728 in the MIS-TLIF group and 3778 in the LLIF group). Indirect meta-analysis, MIS-TLIF provided better postoperative back and leg pain (VAS), disabilities (ODI), and risk of having complications when compared to LLIF technique, but the fusion rate was not significantly different between the two techniques. However, direct meta-analysis between RCT study and pooled indirect meta-analysis of MIS-TLIF have better pain, disabilities, and complication but no statistically significant difference when compared to LLIF. In LLIF, the pooled mean ODI and VAS back pain were 2.91 (95% CI 2.49, 3.33) and 23.24 (95% CI 18.96, 27.51) in MIS approach whereas 3.14 (95% CI 2.29, 4.04) and 28.29 (95% CI 21.92, 34.67) in traditional approach. In terms of complications and fusion rate, there was no difference in both groups. In lumbar interbody fusion, MIS-TLIF had better ODI, VAS pain, and complication rate when compared to LLIF with direct and indirect meta-analysis methods. However, in terms of fusion rates, there were no differences between the two techniques.

Unilateral Biportal Endoscopy or Minimally Invasive Surgery for Transforaminal Lumbar Interbody Fusion? A Comparative Cohort Study.

BackgroundTo determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing.MethodsOf 11,221 middle-aged participants from the Australian Longitudinal Study of Women’s Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated.ResultsOver 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters (‘none or infrequent’, ‘frequent’ and ‘persistent’) for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity.ConclusionBack pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population.