Smoking Failed back syndrome

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ct scan showing markedly thickened ligamentum flavum (yellow ligament) causing spinal stenosis in lumbar spine.


recent studies have shown cigarette smokers routinely fail spinal surgery, if goal of surgery decrease of pain , impairment. many surgeons consider smoking absolute contraindication spinal surgery. nicotine appears interfere bone metabolism through induced calcitonin resistance , decreased osteoblastic function. may restrict small blood vessel diameter leading increased scar formation.


there association between cigarette smoking, pain , chronic pain syndromes of types.


in report of 426 spinal surgery patients in denmark, smoking shown have negative effect on fusion , overall patient satisfaction, no measurable influence on functional outcome.


there validation of hypothetical assumption postoperative smoking cessation helps reverse impact of cigarette smoking on outcome after spinal fusion. if patients cease cigarette smoking in immediate post operative period, there positive impact on success.


regular smoking in adolescence associated low pain in young adults. pack-years of smoking showed exposure-response relationship among girls.


a recent study suggested cigarette smoking adversely affects serum hydrocodone levels. prescribing physicians should aware in cigarette smokers, serum hydrocodone levels might not detectable.


in study denmark reviewing many reports in literature, concluded smoking should considered weak risk indicator , not cause of low pain. in multitude of epidemiologic studies, association between smoking , low pain has been reported, variations in approach , study results make literature difficult reconcile. in massive study of 3482 patients undergoing lumbar spine surgery national spine network, comorbidities of (1) smoking, (2) compensation, (3) self reported poor overall health , (4) pre-existing psychological factors predictive in high risk of failure. followup carried out @ 3 months , 1 year after surgery. pre-operative depressive disorders tended not well.


smoking has been shown increase incidence of post operative infection decrease fusion rates. 1 study showed 90% of post operative infections occurred in smokers, myonecrosis (muscle destruction) around wound.








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