The effect of cigarette smoking and smoking cessation on spinal fusion

Study Design. The effect of cigarette smoking, and smoking cessation on spinal fusion was studied in::a retrospective review of 357 patients who had undergone instrumented spinal fusion. Objective: To document the widely assumed but unreported benefit of cigarette smoking cessation on fusion rate and clinical outcome after spinal fusion surgery. Background Data. Cigarette smoking has been shown:to inhibit lumber spinal fusion and to adversely effect outcome in-treatment of lumbar spinal disorders. Prior reports have compared smokers and nonsmokers, as-opposed to comparing smokers and quitters. Methods. This study retrospectively identified 357 patients who underwent a posterior instrumented fusion at either L4-L5 or L4-S1 between 1992 and 1996. Analysis of the medical record and follow-up telephone surveys were conducted. Clinical outcome and fusion status was analyzed in relation to preoperative and postoperative smoking parameters. Results. in this study, the nonunion rate was 14.2% for nonsmokers and 26.5% for patients who continued to smoke after surgery (P < 0.05). Patients who quit smoking after surgery for longer than 6 months had a nonunion rate of 17.1%. The nonunion rate was not significantly affected by either the quantity that a patient smoked before surgery or the duration of preoperative smoking abatement Return-to-work was achieved in 71% of nonsmokers, 53% of nonquitters, and 75% of patients who quit smoking for more than 6 months after surgery; Discussion. These results validate the hypothetical assumption that postoperative smoking cessation helps to reverse the impact of cigarette smoking on outcome after spinal fusion.