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Quitters Never Win--Except for Smokers Who Need Spine Fusion Surgery
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Posted on: 02/21/2001
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Cigarette smoking is a well-known risk factor for low back pain. Cigarette smoking also has a negative impact on how well smokers do after spine fusion surgery. It's a fact: nonsmokers fare better after spine fusion surgery than people who smoke. However, this study is the first of its kind to compare whether quitting smoking could make a difference for those needing spine fusion surgery.
The authors checked the medical records of 188 cigarette smokers and 169 nonsmokers who had spine fusion surgery between 1992 and 1996. All patients were surveyed by telephone at least two years after their surgery date. Smokers were asked questions about how much they smoked before surgery and whether they had stopped smoking before or after surgery. The amount of time they were tobacco-free was also recorded. All respondents were asked whether they'd gone back to work and how satisfied they were with the results of their surgery.
People who smoked the most before surgery had the hardest time quitting. Nearly 80% of quitters who had smoked less than a pack a day before surgery were still not smoking one month after surgery. This compared to only about 40% of people who had been smoking more than two packs per day.
Those who hadn't quit before having surgery were least likely to quit after their surgery. People who quit before surgery were more likely to be tobacco-free up to six months after surgery. This group also stayed tobacco-free for a longer period of time than those who hadn't quit before surgery.
A key marker of surgery success is whether the bone graft becomes solidly fused. When the bone graft doesn't fuse, the complication is called non-union. Nonsmokers had the fewest instances of the bones non-union. Smokers had significantly more problems with non-union than nonsmokers. And there was a trend showing that people who stayed tobacco-free the longest after surgery had better fusion results than those who hadn't quit.
Going back to work is another way to measure success after surgery. Nonsmokers were more likely to return to work than smokers. However, people who quit smoking for at least six months after surgery showed nearly the same rate of returning to work as nonsmokers. Of people who hadn't quit smoking, just over half were able to return to work; the other half remained disabled.
People who smoked were generally less satisfied with their results than were nonsmokers. Satisfaction scores among smokers were lowest in those who smoked the most before surgery, and satisfaction improved with the amount of time quitters stayed tobacco-free after surgery.
In view of these results, the authors encourage doctors to make every effort to have their patients stop smoking both before and after surgery. "This effort," they conclude, "is justified by the expectation for improvement in fusion rate and the likelihood of return to work, as well as an increase in overall patient satisfaction."
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References:
Steven D. Glassman, MD, et al. The Effect of Cigarette Smoking and Smoking Cessation on Spinal Fusion. In Spine. October 15, 2000. Vol. 25. No. 20. Pp. 2608-2615.
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