IV vs Oral Acetaminophen in Spine Fusion Perioperative Care

Inclusion criteria

• Diagnosis of spinal stenosis of the lumbar spine with degenerative spondylolisthesis
• Skeletally mature adults between the ages of 18-85 years at the time of surgery
• The greater of the patients right and left VAS leg pain, or back pain, score is > 40 mm on a 100 mm scale
• Has attempted conservative therapy
• Psychosocially, mentally, and physically able to fully comply with this protocol, including adhering to scheduled visits, treatment plan, completing forms, and other study procedures
• Personally signed and dated informed consent document prior to any study-related procedures indicating that the patient has been informed of all pertinent aspects of the study

Exclusion criteria

• Any evidence of a prior/current fracture, compromised vertebra, current or past trauma, or tumor at affected level or the spinous processes at the adjacent levels
• Revision of prior fusion attempt at the level being operated on
• Cauda Equina Syndrome defined as neural compression causing neurogenic bowel (rectal incontinence) or bladder dysfunction (bladder retention or incontinence)
• Significant peripheral neuropathy or acute denervation secondary to radiculopathy, caused by conditions other than spinal stenosis
• Significant peripheral vascular disease (diminished dornails pedis or tibial pulses)
• Morbid obesity, defined as BMI > 40 kg/m2; or underweight, defined as BMI < 18.5 kg/m2
• Active systematic or local infection
• Active Viral Hepatitis (receiving medical treatment within 1 year); or any other acute hepatitis within the past 6 months
• Immunocompromised such as but not limited to Acquired Immunodeficiency Syndrome (AIDS), HIV infection, Severe Combined Immunodeficiency Syndrome, Thymic Hypoplasia
• Insulin dependent diabetes mellitus or any other medical conditions that would represent a significant increase in surgical risk or interfere with normal healing
• Immunologically suppressed, or has received systemic steroids, excluding nasal steroids, at any dose for >1 month within last 12 months
• History of Paget's disease, osteomalacia, or osteoporosis with a DEXA t-score less than or equal to -2.5
• Active malignancy. A patient with a history of any invasive malignancy (except non-melanoma skin cancer), unless treated with curative intent and there has been no clinical signs or symptoms of the malignancy >5 years
• Any current history of substance abuse (e.g., recreational drugs, narcotics, or alcohol)
• History of psychosocial disorders that could prevent accurate completion of self-reporting assessment scales
• Previous known allergy to acetaminophen
• Women who are pregnant or lactating
• Patients involved in active litigation relating to his/her spinal condition
• Patients taking >30mg/day of oral morphine sulfate, or the equivalent of this daily for more than 3 months
• Patient is unable to ingest orally administered medication
• Patient receiving autologous Iliac Crest bone graft (ICBG)
• Known intolerance of or true allergy to hydromorphone or oxycodone.
• History of moderate to severe Cirrhosis, defined as Child Pugh score of class B, C, or D
• History of Hemochromatosis or Porphyria
• Patient taking Isoniazid or barbiturates