Smoking is just about the worst thing you can do to your body, and we have previously written blogs about tobacco/ nicotine’s direct detriment to the spine. Again, it is not just tobacco or smoking per se… nicotine in any form may be directly responsible for cell damage to the disc’s annulus and nucleus. Bone exposed to nicotine exhibits significantly less relative fusion strength and stiffness. Nicotine use may increase the risk of postoperative infection. Therefore nicotine supplements and/or vaping may be no better than smoking a cigarette.
Tobacco cessation can reduce the risks of these complications, depending on the duration and timing of abstinence. Improved fusion rates, pain scores and return to work rates tend to be observed in individuals who quit for more than 6 months after surgery. Not to be pessimistic, but about 50% of quitters relapse at some point in the postoperative period. In some studies looking specifically at spine surgery patients, 90% of those who successfully quit for 6 months or more did not need the aid of nicotine-containing gums/ patches or other medications. This may call to question this method of cessation in the spine surgery population.
A patient’s ability to stop smoking before surgery likely is a predictor of the outcome as well. I commonly am asked, “How long before surgery do I need to quit?”
Of course, the answer is always, “now”. However new research from the World Health Organization suggests that quitting at least 4 weeks before elective surgery may allot better outcomes. Of course, the optimum length of cessation may vary a bit based on which complication is being avoided. And quitting 4 weeks or longer before surgery does not completely eliminate a prior smoker’s increased risk of complications.