How smoking affects success and recovery after spine surgery

20.12.2022.

Whether you're just getting ready for spine surgery or recovering, smoking is just as bad for you and it's time to quit. At least until surgery and recovery are a thing of the past.

The harmful effects of tobacco and marijuana use on the spine, before, during and after surgery are indisputable. Do everything in your power to refrain from tobacco and marijuana use before and after spine surgery, especially if fusion surgery is planned.

Successful outcomes after cervical and lumbar fusion surgeries depend on the formation of new bone and the achievement of solid bony fusion.

Cigarette smoke contains over 4,000 different chemical compounds, including carbon monoxide. Carbon monoxide has been shown to increase the risk of poor tissue oxygen levels, leading to impaired bone formation as well as impaired wound healing with a risk of infection.

Carbon monoxide is recognized as a "bone poison" with regard to the formation of new bone. This poses a critical risk of poor recovery from surgery with chronic pain due to failed fusion.

In women, cigarette smoke lowers estrogen levels, leading to osteoporosis and osteopenia and generally poor bone quality for healing, including other problems such as an increased risk of vertebral compression fractures.

Nicotine leads to the release of catecholamines, causing constriction of blood vessels and further damage to normal blood flow. Without adequate blood flow, bone-forming cells (osteoblasts and osteocytes) cannot adequately perform their functions and form new bone. Also, tobacco-based chemicals have been shown to accelerate the normal degeneration of spinal discs, ligaments, and joints, accelerate the rate of osteoarthritis, and lead to chronic neck and back pain.

Marijuana is just as harmful. Among its 500 known harmful chemical ingredients is the active compound tetrahydrocannabinol (THC). THC has been proven to be a powerful immunosuppressant, inhibiting the body's ability to fight infections and eliminate precancerous cells.

Postoperative complications attributed to smoking include the following:

  • significantly reduced rate of successful fusion (so-called nonunion or pseudarthrosis) because the bone graft does not receive enough nutrients due to the lack of blood supply and therefore does not grow and cannot form a fusion
  • higher rate of postoperative infection and fluid accumulation
  • higher rates of chronic postoperative pain associated with incomplete fusion, especially in people with multilevel surgery, whether the procedure is anterior or posterior
  • higher risk of pneumonia and symptomatic heart disease
  • longer time period of wound healing
  • higher rate of postoperative blood clots (deep vein thrombosis)
  • higher chances of reoperation
  • longer hospital stay after surgery
  • poor functional rehabilitation after surgery
  • lower overall patient satisfaction with spine surgery

How long before surgery to stop smoking and when you can start again after recovery

The optimal time period between the cessation of all forms of tobacco and marijuana use (including nicotine gum, lozenges, sprays, vapers, and puffers) remains unclear.

Studies suggest that an abstinence period of 6 months is optimal. You should also refrain from using tobacco for at least 3 months or longer after surgery to allow bone formation and fusion.

In summary, the widespread adverse effects of tobacco use prior to cervical fusion surgery are not worth the risk of a poor outcome.

If you're a smoker, it's your job to quit completely before surgery, by any means necessary.

Regardless of technical advances in achieving solid fusion in smokers, the best overall results, particularly pain relief, are achieved in non-smokers and smokers who have successfully quit smoking.

We wish you a fast and successful recovery!

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