Patient’s often respond with questioning about their smoking habits with “I know…..I know”. We all know the negative effects of smoking in regards to cancer and pulmonary function. What about Spine Surgery? Whether it’s basic science or clinical studies……the evidence is undeniable; smoking is bad for you!
Multiple basic science studies have shown smoking leads to increased spinal disc degeneration, osteoporosis, arthritis and delayed fracture healing. For the spine, the issue is blood supply. As we age, the bloody supply to the discs decreases, which causes the disc to age prematurely. One well referenced study showed that 30% of patients in their 20’s have MRI evidence of disc degeneration……and no symptoms. Another study on young rats has shown exposure to cigarette smoke caused disc cracks and scarring. These changes to the disc can lead to premature wear and tear. There have been associations between smoking and disc herniations and painful discs that can lead to surgery.
In addition, smoking causes decreased outcomes and increased risks with Spine Surgery. For example, neck and low back fusion surgeries have increased non-union rates (inability to grow new bone) in smokers vs non smokers. One study by Howard An, MD from Chicago shows a nonunion rate nearly 3X higher in the cervical spine with smokers vs non smokers and nearly 2X higher in the low back. Other complications associated with smoking include delayed wound healing and increased infection rates.
So what do you do if you smoke? Thankfully, the effects of smoking can be minimized if you stop………sooner than later. Studies have shown a decrease in wound healing issues and infection with at least 4 weeks of smoking cessation prior to surgery. Also, by continuing not to smoke as your fusion surgery heals (typically 4-6 months) will improve your fusion rates.
Ultimately, if you have back or neck issues, stopping smoking can help improve your back health and hopefully avoid a trip to the doctor!
Paul Saiz, MD