Understanding Smoking’s Impact on Healing from Spine Surgery

According to a recent article that appeared in the journal Orthopedics Today, nicotine’s negative effects on bone and soft tissue are so great that surgeons should be actively communicating them to patients and working to help them quit prior to conducting their surgeries. Though experts concede that smoking cessation is extremely difficult, an increasing number of physicians are taking the position that the damage tobacco use does to the musculoskeletal system, to the body’s ability to heal and the increased risk of post-surgical infection makes doing so essential.

Though patients may not be aware of the statistics, patients who smoke or use tobacco have increased postoperative morbidity and mortality. Additionally, those patients who smoke are at higher risk for degenerative disc disease and do not heal as quickly after surgery. According to Orthopedics Today Editorial Board Member Jeffrey A. Goldstein, M.D., who is director of the spine service and director of the spine fellowship program at NYU Langone Orthopedic Hospital and NYU Langone Health, “I think we all agree nicotine is a poison, and it’s not good for anybody; but specifically to spine surgery, it’s a poison when it comes to spinal fusion It is in their best interest for patients to stop smoking prior to surgery.”

Echoing Goldstein’s assertion, trauma surgeon Paul E. Matuszewski, MD of the University of Kentucky said, “Smoking has been shown to be associated with an increased rate of complications and poor outcomes in elective and trauma orthopedic patients. While patients know the general negative effects of smoking, they are less apt to know the effects of smoking on bone and wound healing. As such, orthopedists have the unique ability to educate during this teachable moment and effect change in patients who may not otherwise interact with the health care system.”

There are numerous reasons why smoking cessation is so important prior to spinal surgery. Smoking affects every tissue in the musculoskeletal system. It decreases bone mineral density, raising the risk of osteoporosis and fractures and slowing healing. This is true whether the patient smokes cigarettes, pipes, or cigars. Notably, many patients who vape or smoke e-cigarettes believe that they are avoiding the negative effects of nicotine, but that is not the case.

Recent studies have emphasized the role that spine surgeons can plan in educating their patients about the negative impact that nicotine is having on their spine health and encouraging them to quit. Healing from the damage of smoking begins almost immediately, and many surgeons have begun recommending that patients stop smoking for at least six weeks prior to their scheduled surgery. Doing so has a marked impact on healing, and one that is far greater than is true of patients who only quit a few days before their surgeries. Many physicians are providing their patients with a variety of smoking cessation tools in order to help them with the process.

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