The effect of cigarette smoking and smoking cessation on spinal fusion

Study Design. The effect of cigarette smoking, and smoking cessation on spi nal fusion was studied in::a retrospective review of 357 patients who had u ndergone instrumented spinal fusion. Objective: To document the widely assumed but unreported benefit of cigaret te smoking cessation on fusion rate and clinical outcome after spinal fusio n surgery. Background Data. Cigarette smoking has been shown:to inhibit lumber spinal fusion and to adversely effect outcome in-treatment of lumbar spinal disord ers. Prior reports have compared smokers and nonsmokers, as-opposed to comp aring 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 19 96. Analysis of the medical record and follow-up telephone surveys were con ducted. Clinical outcome and fusion status was analyzed in relation to preo perative 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 wh o quit smoking after surgery for longer than 6 months had a nonunion rate o f 17.1%. The nonunion rate was not significantly affected by either the qua ntity 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 af ter surgery; Discussion. These results validate the hypothetical assumption that postope rative smoking cessation helps to reverse the impact of cigarette smoking o n outcome after spinal fusion.