Surgeons Explain Damage Caused by Smoking After Surgery

A recent study presented at the 31^st Annual Meeting of the North American Spine Society (NASS) shows how smoking may harm the body’s healing process after spinal surgery. The research showed that the healing process is stunted by smoking so many tobacco products before and after surgery. 

“While it is well-established that smoking compromises healing from spine surgery, this new study suggests that improvement is actually tobacco-dose dependent,” said Alan S. Hilibrand, MD, an orthopedic surgeon and 2016 NASS Annual Meeting Program Chair. “This study gives spine specialists important data to help them counsel patients to quit smoking as early as possible.”

Dr. Chad Patton, MD, also an orthopedic surgeon out of Maryland, explained the correlation between smoking and the effects on the recovery period. 

“Smoking has adverse effects on healing from any type of surgery,” Patton said. "In particular, with spine surgery, we’ve got to think about smoking because of the effects primarily causing restriction of those blood vessels.”  

These affect overall wound healing, with spinal fusion surgery specifically, causing bone to deteriorate faster, Patton said. 

“The Effects of Smoking on Spinal Cord Healing Following Surgical Treatment for Cervical Myelopathy” was selected as one of the best research literature at the NASS meeting. 

Cervical Myelopathy is a common, progressive condition that generally impacts older people aged 50-60. The symptoms range from clumsiness with hand movements, such as buttoning clothes, to unsteady walking, according to a NASS press release.

"This new paper clearly showed that it has adverse effects on neurologic healing," Patton said.

One of the conditions from Cervical Myelopathy includes compression on the spinal cord. After pressure is released, the spinal cord heals by maintaining good vascular flow, Patton explained.  Because smokers have constricted flow with getting to these important areas, healing doesn't work as well as on people who didn't smoke prior to surgery. 

The study reported that one surgeon’s 212 consecutive patients with Cervical Spondylotic Myelopathy, (a neck condition that arises when the spinal cord becomes compressed or squeezed), were categorized into two groups, which were classified by packs of cigarettes smoked a year and per day.

Please note that "a pack year" is defined as 20 cigarettes smoked every day for one year.

Each patient was assessed and given a pre-and postoperative Nurick scale rating, which the press release describes as a patient's difficulty in walking, from 0 to 5, with five being the most severe. This matched with the age, sex, health conditions, and other factors with participants yielding the following test results.

Results:

Nonsmokers, postoperative, yielded 1.53 points on the Nurick scale, compared with just 0.6 points in smokers. However, there was a progressive decrease in improvement as the number of pack years and packs per day increased.

There was a greater improvement in the Nurick score with a higher preoperative score, but only in patients with fewer than 25 pack years.

Thoughts on Research 

David Kusin, MD, of the University of Nebraska Medical Center in Omaha, explained smoker history was not associated with severe preoperative conditions, and suggested that smoking may interfere with the intrinsic healing period that occurs in the spinal cord post-surgery.

“The data suggest that patients with Cervical Myelopathy who smoke are likely to have less improvement in their condition postoperatively, compared to those who do not smoke, and that the effect of each cigarette is additive,” Kusin said. “These findings reinforce the importance of counseling patients about smoking cessation prior to surgery."

The authors of the study are David Kusin, MD, from the University of Nebraska Medical Center, Omaha, New England and Nicholas U. Ahn, MD, from the Department of Orthopedic Surgery, University Hospital of Cleveland, Cleveland, Ohio.

More than 3,500 spine professionals met at this year’s conference in Boston. The scientific program offered more than 800 presentations, including symposia, paper sessions, ePosters, instructional courses and hands-on courses.