COMPARISON OF SMOKING-HABITS BETWEEN PATIENTS WITH SURGICALLY CONFIRMED HERNIATED LUMBAR AND CERVICAL DISC DISEASE AND CONTROLS

There have been numerous studies that implicate cigarette smoking as a risk factor for the development of back pain or disc disease. The pur pose of this article is to review patients who underwent surgery for c ervical or lumbar radiculopathy and to investigate the relationship be tween cigarette smoking and development of surgical disc disease. A ci garette smoking study of 205 surgical patients with lumbar and cervica l disc diseases was done, with the surgical patients compared to 205 a ge-sex-matched inpatient controls during 1987-1988. This study was con ducted at the Pennsylvania Hospital in Philadelphia, Pennsylvania. The re were 163 patients with lumbar disc disease and 42 patients with cer vical disc disease. The ratio of men to women was 1.5:1 for lumbar dis c and 2.5:1 for cervical disc disease. Smoking history (current and ex -smokers) was strikingly increased in both prolapsed lumbar interverte bral disc (56% vs. 37% of controls, p = 0.00029) and cervical disc dis ease (64.3% vs. 37% of controls, p = 0.0025). Calculated relative risk s for smokers were 2.2 for lumbar disc and 2.9 for cervical disc disea ses. This association between cigarette smoking and disc disease was m ore significant when comparing between current smokers versus nonsmoke rs (p = 0.000011 for lumbar disc disease, and p = 0.00064 for cervical disc disease). Relative risks for current smokers were 3.0 for lumbar disc and 3.9 for cervical disc diseases. This correlation was signifi cant for both males (p = 0.000068 for lumbar disc disease, p = 0.043 f or cervical disc disease) and females (p = 0.0 1 8 for lumbar disc dis ease, p = 0.006 for cervical disc disease). There were no statisticall y significant differences between ex-smokers versus nonsmokers. Only 1 0 of 26 ex-smokers quit smoking within 5 years in the disc disease gro up, and 16 of 38 ex-smokers in the control group quit smoking in the l ast 5 years of admission. This study confirms previous reports on the association between disc disease and cigarette smoking. This study is different from previous reports in that surgically confirmed patients were studied in this investigation. All patients had severe discogenic and radicular symptoms to require surgery. The following speculations can be made from this study: (a) The association between cigarette sm oking and intervertebral disc disease is more significant in the surgi cal group than the non-surgical group as previously reported. (b) Cont inued cigarette smoking may aggravate discogenic or radicular symptoms in patients with intervertebral disc disease. (c) Stopping cigarette smoking may have beneficial effects as no significant differences were found between ex-smokers versus nonsmokers.