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The Effect of Smoking on Neck Surgery: It's Not Just Smoke and Mirrors

Posted on: 11/30/1999
By now it comes as no surprise that smoking is a far from healthy habit. Smoking is hard on the heart, lungs, and immune system. It also poorly affects the success of certain surgeries, such as low back surgery. Does smoking also have a negative impact on the results after neck surgery?

Fifty-five smokers and 135 nonsmokers had surgery to fuse the vertebrae in their necks. Fusion surgery is used to get two or more bones to grow together into one solid bone. One type of surgery used in this study, called interbody grafting, involved placing bone grafts between the vertebral bodies. Another type, strut grafting, involved removing several vertebral bodies and putting in a long column of bone to replace the vertebral bodies.

Two years after surgery, nonsmokers showed better neck fusion than smokers. Nonsmokers also reported less neck pain. The only exception to this was in the case of strut grafting, which had the same results for smokers and nonsmokers. This may be because the interbody procedure involved putting bone in at multiple points in the neck. So at least four separate surfaces had to heal. Strut grafting, by contrast, involved only two surfaces.

Not surprisingly, patients whose necks healed properly also felt better. With this in mind, the authors want to find ways to improve the rate of neck fusion for smokers. The best way, of course, is to get patients to quit smoking. In the meantime, the authors prefer the strut-graft method for smokers who need to have a longer section of their neck bones fused.

Alan S. Hilibrand, MD, et al. Impact of Smoking on the Outcome of Anterior Cervical Arthrodesis with Interbody or Strut-Grafting. In The Journal of Bone and Joint Surgery. May 2001. Vol. 83-A. No. 5. Pp. 668-673.

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