Smoking and Its Negative Effect on Spine Fusions

Smoking and your Surgery

If you are a nonsmoker or have stopped smoking longer than 2 months prior to spinal fusion surgery, your chances for a successful outcome are improved, according to researchers. In cervical (neck), thoracic (midback), or lumbar (low back) spinal fusion surgery, the results were significantly better for people who never smoked and for those who stopped smoking compared to those who continued to use nicotine products.

Smoking and Spinal Fusion Surgery

Patients who have failed conservative treatment to address their spine related pain may be faced with the prospect of surgical intervention. Treatment may include fusing or mending two or more vertebra together to help reduce instability and pain. The process of mending two bones together and creating a fusion is often difficult under ideal circumstances and its success will hinge on issues such as blood flow, adequate oxygenation of the blood, the patient overall physical condition, and many other medical conditions that adversely affect the bones of the body to heal properly.

A solid fusion or union of the bones of the spine together will indicate a radiographic success and when properly applied with good indications can reduce pain and disability, thus improving the patient’s ability to return to their activities of daily living.

Creating this solid fusion in diabetics, smokers, as well as a host of metabolic conditions is difficult. The reason why smoking has such a significant negative affect on the healing of all tissues especially bone is multi-factorial.

Carbon monoxide is a byproduct of tobacco that competes with oxygen at the level of the red blood cells. Our normal red blood cells are looking to pick up oxygen in the lungs as it passes through. In a patient who are smoking, these cells will pickup and distribute throughout the body an increased concentration of carbon monoxide instead of normal concentrations of life giving oxygen.

Nicotine which is also a byproduct of tobacco will be liberated into the blood stream and acts as a constrictor of the blood vessels. There is therefore a reduced amount of blood due to the smaller vasculature, being circulated to the areas that need to heal.

There has been many studies that have exposed the negative affect of smoking on human health. Drawn from these studies are startling statistics that paint a very negative picture when it comes to spinal fusions in smokers. Success rates for non-smokers undergoing lumbar fusion surgery was 80 to 85 percent. For those who chose to continue to smoke, they can expect a reduced success rate that is often less than 73 percent. The success of surgery will impact directly the person’s ability to return to work and normal activities of daily living. We have seen similar differences in success rates for those undergoing neck (cervical) fusions. Nonsmokers can expect a 81 percent chance of success and smokers will see at best a 62 percent chance of success.

Impact of Smoking on Health

Smoking is the number one cause of preventable death. More than 440,000 people per year die in the United States from tobacco-related diseases. Smokers can expect to live 7 to 10 years less than those who have not smoked. Smoking is linked to heart and respiratory diseases and to several cancers. In addition, smoking has a significant impact on your bones and joints, and can help to accelerate the age related changes we often see in all joints including the discs of the spine.


•Smoking and nicotine increases your risk of osteoporosis with reduced bone density, by reducing the blood supply lines to bone.

•Smoking increases the risk of a hip fracture in the elderly population.

•Smokers were 1.5 times more likely to suffer overuse injuries than nonsmokers.

•Smoking has a negative effect on bone and wound healing.

•Fractures take longer to heal in smokers secondary to nicotine on bone-forming cells.

•Smokers have a higher rate of complications and poorer outcomes after surgery than nonsmokers.

•Smoking reduces athletic performance.

•Smoking slows lung growth and impairs lung function; there is less oxygen available for muscles used in sports.

•Smokers suffer from shortness of breath almost three times more often than nonsmokers, and smokers cannot run or walk as fast or as far as nonsmokers.

•Smoking increases your risk of suffering with chronic low back pain.

Quitting smoking now will improve many of your odds in the future related to long term survival, musculoskeletal health, and surgical success if you find yourself without another choice. For more information, please visit the American Lung Association web site or consult your Primary Care Physician for more information and help kicking the habit.