Spinecare Topics
Smoking and the Spine
There is a growing body of evidence which confirms that cigarette smoking adversely affects the integrity of surgical spinal fusions. In order for a spinal fusion to heal, new bone growth must occur to bridge across adjacent spinal segments to provide stability. Smoking disrupts the normal capacity of bone in the spine to form and grow. Adequate bone growth is required for a spinal fusion to work. Smoking compromises normal bone metabolism which involves the spine. The negative physiological changes include small artery (arteriolar) constriction, lack of oxygen to bone cells (cellular hypoxia), thinning of bone (demineralization), and delayed growth of new blood vessels (delayed revascularization). Research has shown that smokers who undergo fusion take longer to heal and have a higher incidence of non-union.
Bony fusion is often combined with the use of man made instrumentation to help ensure stability of the spine. Examples of fabricated instrumentation include hooks, rods, wires, screws and plates which are attached to the spine. These types of devices provide immediate stability and hold the spinal segments in place until the bony aspect of the fusion heals and provides biological stability. The long-term success of many types of spinal surgery is dependent upon successful spinal fusion. A failed fusion may lead to the need to undergo another operation. Subsequent operations are often associated with additional risk factors including the development of more scar tissue (fibrosis).
Cigarette smoking interferes with normal immune system function. It subsequently increases and individual’s risk for acquiring an infection, of particular importance for the patient who is going to undergo spine surgery. Smoking also increases the likelihood of developing excessive scar tissue, a critical factor when considering spine surgery.
People who are going to have spinal surgery should make every effort to stop smoking. Quitting the habit before surgery will decrease the risk for complications and promote a better surgical outcome. Studies indicate that smoking is most likely to be a risk factor for LBP in people with jobs that require heavy physical exertion.
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