Patients are usually told by members of the medical fraternity to stop smoking, but is there any science behind this request or is it just a standard order given to patients? We will take a short look at what the evidence says in terms of smoking in people with spinal problems and those receiving spinal surgery.

Smoking has been shown to accelerate disc degeneration1 and in patients where discectomies were done, the rate of recurrent herniation was much higher than in non-smokers2. Therefore smoking does not only increase the risk of spinal problems, but also has negative effects after the surgery.  When patients with spinal problems received spinal care and were followed up, it was found that smokers who stopped smoking during the course of their treatment, improved significantly in terms of their pain scores compared to those who continued to smoke3.

Patients with lumbar spinal stenosis who received decompression surgery were followed up for 12 months after surgery by measuring their functional status using the Oswestry Disability Index4. Amongst the risk-factors for deterioration in the 12 month period following the surgery was cigarette smoking. Smokers are also less likely to improve after microdecompression surgery5. This is proposed to be due to the influence smoking has on the mineral metabolism in the vertebrae6

It has been shown that smoking increases the risk of surgical site infection7. Smoking increases white blood cells which fight off infection, but the function of the white blood cells are significantly affected, as well as other immune functions, leading to increased risk of infection.  The risk of post-surgical problems in smokers extend to the healing of spinal fusions too. The risk of a smoker developing non-union after spinal fusion is also up to four times higher than in non-smokers8.

If smoking is stopped as little as 4 weeks before surgery the risks of complications in the period after surgery is reduced significantly. If smoking is stopped shortly before surgery, there is no increased risk of complications as previously suggested9.

Osteoporosis leads to a higher risk of fractures and smoking is one of the modifiable risk factors in developing the problem10. Smoking especially increases the risk of spine and hip fractures11.  If the evidence has convinced you to kick the habit, where can you get help to stop smoking?

  • Online help from www.ekickbutt.co.za in association with Cansa
  • Speak to your GP about medication that can help you quit
  • Join a programme such as Stop Smoking Clinic (www.stopsmokingclinic.co.za) or I Quit Smoking (www.iqssouthafrica.com)

  1.   An HS, et al. Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls. J Spinal Disord 1994;7:369-373
  2. Shin B-J. Risk factors for recurrent lumbar disc herniation. Asian Spine J 2014;8(2):211-215
  3. Behrend C, et al. Smoking cessation related to improved patient-reported pain scores following spinal care in geriatric patients. Geriatr Orthop Surg Rehabil 2014;5(4):191-194
  4. Nerland US, et al. The risk of getting worse: Predictors of deterioration after decompressive surgery for lumbar spinal stenosis: A multicenter observational study. World Neurosurgery 2015;84(4):1095-1102
  5. Sanden B, et al. Smokers show less improvement than nonsmokers two years after surgery for lumbar spinal stenosis: A study of 4555 patients from the Swedish spine register. Spine 2011;36:1059-1064
  6. Hadley MN, et al. Smoking and the human vertebral column: A review of the impact of cigarette use on vertebral bone metabolism and spinal fusion. Neurosurgery 1997;41:116-124