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SRS-22r question 11 is a valid opioid screen and stratifies opioid consumption



To validate the Scoliosis Research Society-22r (SRS-22r) question 11 (Q11) response as a measure to assess and quantify opioid consumption.


A post hoc analysis of a prospective study regarding opioid use during ASD surgery was performed. Data were collected at enrollment and 2-year follow-up including the SRS-22r and a standardized data collection form (CRF) for self-reported opioid consumption. Responses to Q11 of the SS-22r were compared with responses to the opioid consumption CRF (as measured by morphine equivalent dose (MED)). Inter-rater agreement was calculated. Sensitivity and specificity for the Q11 (+) responses were calculated using MED reports as the “true” value.


Cohen’s kappa indicated almost perfect agreement between the MED CRF and Q11 (k = 0.878, p < 0.001). Mean daily MED consumption for patients reporting “Daily Narcotic” use was 62.0 (Median: 38.7, SD 87.5) mg; for patients reporting “Narcotics weekly or less”, mean daily MED consumption was 21.6 (15.0, 29.0) mg. The positive Q11 responses were 96% sensitive and 92% specific for opioid users.


SRS-22r Q11 exhibits almost perfect agreement with an independent questionnaire designed to assess opioid consumption in this cohort. “Daily narcotic” users report nearly three times the mean daily MED of “Weekly or less” users (62.0 ± 87.5 mg vs 21.6 ± 29 mg, p = 0.037). Q11 exhibited excellent sensitivity and specificity for determining opioid users and non-users. Given the need for opioid research in ASD, Q11 may be useful to use existing registries and observational cohorts to design more definitive studies regarding opioid consumption.

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Authors and Affiliations



PI, TSC—analyzed data and drafted initial manuscript; SB, JLB, BL—conceived initial study and approved final manuscript; LGL—conceived initial study, assisted with data collection, approved final manuscript; MPK—conceived initial study, collected and analyzed data, critically revised manuscript and approved final manuscript.

Corresponding author

Correspondence to Michael P. Kelly.

Ethics declarations

Conflict of interest

Drs. Inclan, CreveCouer, Line, and Kelly report no conflicts of interest. Dr. Lenke reports being a consultant for Medtronic (money donated to charity); receiving royalties from Medtronic and Quality Medical Publishing; receiving reimbursement for airfare and hotels from Broadwater, the Seattle Science Foundation, Stryker Spine, the Spinal Research Foundation, AOSpine, and the Scoliosis Research Society; receiving grant support from the Scoliosis Research Society (money to his institution), EOS Imaging (money to his institution), the Setting Scoliosis Straight Foundation (money to his institution); and receiving grant and fellowship support from AOSpine (money to his institution). Dr. Bess receives royalties from K2M/Stryker; consulting fees from K2M Stryker, Mirus; grants to institution from DePuy Synthes, Medtronic, Globus, K2M Stryker, Nuvasive. Dr. Gum reports Acuity: IP royalties; Paid consultant, American Journal of Orthopedics: Editorial or governing board, Cingulate Therapeutics: Stock or stock Options, DePuy, A Johnson & Johnson Company: Paid presenter or speaker, K2M: Paid consultant, MAZOR Surgical Technologies: Paid consultant, Medtronic: Paid consultant, Nuvasive: IP royalties; Paid consultant, Stryker: Paid presenter or speaker, The Spine Journal—Reviewer: Editorial or governing board.

Ethical standards

This project was approved by the local Institutional Review Board (IRB #201311105). Paul Inclan: analysis, interpretation, drafting/revising, final approval, agree to accountability. Travis S. CreveCoeur: interpretation, drafting/revising, final approval, agree to accountability. Shay Bess: conception/design, interpretation, drafting/revising, final approval, agree to accountability. Jeffrey L. Gum: conception/design, acquisition of data, interpretation, drafting/revising, final approval, agree to accountability. Breton G. Line: conception/design, interpretation, drafting/revising, final approval, agree to accountability. Lawrence G. Lenke: conception/design, acquisition of data, drafting/revising, final approval, agree to accountability. Michael P. Kelly: conception/design, acquisition of data, analysis, interpretation, drafting/revising, final approval, agree to accountability.

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Inclan, P., CreveCoeur, T.S., Bess, S. et al. SRS-22r question 11 is a valid opioid screen and stratifies opioid consumption. Spine Deform 10, 913–917 (2022).

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  • Adult spinal deformity
  • Opioid
  • SRS-22
  • Morphine equivalent dosing
  • Narcotics