How smoking habits impact recovery from back surgery
Smoking has been linked to various issues with the spine in the past
Those who smoke tobacco regularly may not be giving their backs the best of chances when it comes to particular problems and recovering from them, as tobacco smoking is considered a significant risk factor for complications after surgery. Smoking is also associated with impaired tissue healing and increased risk of pulmonary and cardiovascular complications after elective orthopedic surgery. Additionally, it increases the risk for lumbar disc degeneration (condition that leads to low back pain) and disc herniation (when cushions between vertebrae are pushed out of their normal position), and it inhibits spinal fusion (surgical procedure that fuses two vertebrae). Based on these connections, it already appears the relationship between smoking and back problems is not a healthy one. Lumbar spinal stenosis (LSS), a condition in which the narrowing of the spinal canal leads to pain in the lower back (lumbar region), is the most common reason for performing surgery in patients over 65, but no associations have yet been found between smoking and recovering from surgery for LSS. Therefore, a study was conducted to investigate the possible relationship between smoking and LSS surgery recovery based on results taken two years after surgery.
Massive study group evaluated for smoking habits and progress after surgery
The National Swedish Register for Spine Surgery is a database that records information on the majority of lumbar spinal procedures in Sweden, taking note of age, sex, smoking habits and working conditions prior to surgery, and giving out follow-up questionnaires on leg and back pain for up to two years after surgery. Using this, a total of 8,024 patients with a diagnosis of LSS served as possible candidates for the study, and information on each of them was screened for eligibility. Almost half of these candidates were excluded for reasons such as not completing the two-year follow-up or failing to report smoking habits, leaving a sample of 4,555 patients for the study group. Data regarding the smoking habits and level of improvement following surgery was then evaluated to determine if a connection between the two existed.
Smokers shown to improve less than nonsmokers
Of the 4,555 patients in the study, 758 (17%) defined themselves as smokers at the time of surgery, and these patients were generally younger than nonsmokers and had slightly more disability symptoms before surgery. Overall, according to results from the questionnaires and other tests, smokers fared worse than nonsmokers following surgery, and they also experienced more pain at the two-year follow-up. Specific results showed that the nonsmoking group had a more positive attitude toward results of the surgery, with 63% being satisfied compared to 54% of smokers, and they also returned to work more frequently (51% for nonsmokers vs. 36%). Regular use of analgesics was higher for smokers (40%) than nonsmokers (30%), even though there was no difference between the two prior to surgery, and the walking ability of smokers did not improve nearly as much as it did for nonsmokers. Finally, nonsmokers had less back and leg pain, and a higher Quality of Life (QoL) compared to smokers within the two years after surgery.
These results clearly point out the negative association between smoking and recovery from lumbar surgery, as smokers are shown to have a much more difficult time "getting back to normal" than nonsmokers. Some possible explanations for why this may exist are as follows: smoking decreases the blood flow to certain parts of the vertebrae, which can lead to an increased degeneration of discs. Another cause may be that the increased coughing from smoking increases pressure on the abdomen and vertebrae, which can lead to a herniated disc and possibly LSS, and finally, smoking has been associated with a decrease in bone mineral density (BMD) and osteoporosis, both of which can also cause pain. Whatever the specific mechanisms at work are, the connection between the two is unmistakable. Nonetheless, smokers should not be dissuaded by this study to not undergo surgery, but conversely, should treat this as motivation to stop smoking if surgery is on the horizon, as other studies have shown stopping smoking 4-8 weeks before surgery has led to fewer complications. On an already long list of reasons not to smoke regularly, add this newly found association to the stack.
-Summarized by Greg Gargiulo
-As reported in the June 11 edition of Spine
