Patients often ask about the effects of smoking on spinal fusion surgery. Nicotine has a significant negative impact on the human musculoskeletal system by lowering bone mineral density, contributing to intervertebral disc degeneration, and limiting the restoration of the blood supply to bone grafts. Numerous studies have shown that smoking also (1) slows the production of bone-forming cells (osteoblasts) thereby increasing the time required for healing, (2) impairs the absorption of calcium, and (3) increases the risk of bone fracture. Other studies have found a direct link between smoking and low-back pain independent of surgical intervention.
Spinal fusion, the permanent surgical immobilization of two or more adjacent bones (vertebra) of the spinal column, has become the standard of care in the United States with more than 500,000 spinal fusions performed annually on the neck and low back. The effects of smoking should be of particular concern for individuals who undergo a fusion in the lumbar and cervical regions of the spine. Smoking causes an increased rate of pseudarthrosis, the failure of bone to fuse following spinal fusion surgery. This leads to increased postoperative pain. Studies of lumbar and cervical fusions consistently show that successful fusions occur in a significantly higher percentage of nonsmokers than smokers.
Finally it should be noted that cigarette smoking is a significant risk factor for the development of postoperative complications such as deep wound infection, improper healing and bone graft pain.
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