Smoking and Spinal Stenosis Back Pain

smoking and back pain spinal stenosis surgery risk

Smoking may halve your chances of success with spinal fusion surgery.

It is fairly clear, or should be, that smoking is not a sensible course of action for leading a healthy life. Those who smoke, or have ever smoked have a higher likelihood of developing back pain, with adolescents particularly at risk of lower back pain connected to smoking (Shiri, 2010). Smokers also have an increased risk of spine fracture, along with hip fracture (Vestergaard, 2003), with women increasing their risk of vertebral fracture by 13% and men by a massive 32% if they smoke (Ward, 2001). What’s more, smoking may prevent you from being offered surgery to help back pain, seriously hinder any recovery if you are given the opportunity for spinal stenosis surgery, and is even linked to increased risk of fatality after spinal surgery as it increase the risk of infections.

Why does smoking affect surgery success?

Why does smoking have such a huge effect on recovery rates and success? Well, a number of studies have demonstrated a link between nicotine and poor bone mineralization, along with reduced circulation, poor nutrient delivery, nutrient deficiencies, and inhibited growth of new bone. Smokers who undergo spinal fusion surgery have a significantly lower rate of success, with one study finding that smokers had failed fusions in 40% of cases compared to just 8% of non-smokers (Brown, 1986). Another study found that 50% of smokers had failed fusion after an anterior cervical discectomy compared to 20% of non-smokers (Goldberg, 2002). This alone is reason enough for surgeons to postpone such operations for spinal stenosis until a patient has successfully quit smoking and has minimal traces of nicotine in their system.

The Nicotine Factor

Why does smoking have an effect on post-surgical fusion? Well, it is most likely connected to the nicotine content of tobacco, as research by Theiss (2000) showed that nicotine inhibits gene expression controlling both type I and type II collagen, bone morphogenic protein-2, -4, and -6, basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF). What does that actually mean though? In non-medical jargon, this inhibition of specific chemical substances in the body (cytokines) means that the growth of new bone cells and the blood vessels to supply them is seriously impaired when nicotine levels in the blood are raised. After surgery for spinal stenosis the body needs to be able to rapidly create new bone to fuse the vertebrae and restore some level of stability in the spine. Smoking has a huge impact on that success.

Nicotine and Pain Medications

Interestingly, smoking has another effect alongside the poor fusion rate; it increases the level of pain medication patients use in conditions such as a herniated disc or spinal stenosis-related back pain (Krebs, 2010). Smokers also tend to continue using opioid pain medication for longer than non-smokers in these conditions (Krebs, 2010). Iwahashi (2002) examined the effect of nicotine on the health of the intervertebral discs and found a significant progression of disc degeneration in cases of nicotine exposure. The discs showed problems in the annulus fibrosus (the fibrous outer ring of the disc), and necrosis of the nucleus pulposus (the gel-like center of the disc). These pathological changes in the discs led to stenosis of the blood vessels in the vertebral spine and calcification, hypertrophy, and necrotic changes of the whole spinal vascular system. This inhibition of correct circulation and blood vessel health in the spine means that any degenerative spinal condition, such as spinal stenosis, is likely to benefit from smoking cessation. Nicotine intake reduces synthesis of proteoglycan and collagen, making it responsible for poor repair of skin and connective joint tissue everywhere in the body. The problems with circulation and collagen synthesis connected to smoking are most likely instrumental in the poor prognosis for smokers after any kind of surgery as concerns heart health. The most common cause of death after non-cardiac surgery, such as a procedure for spinal stenosis, is cardiac failure, with smokers particularly at risk (Faciszewski , 2001).

Another Reason to Quit Smoking

In cases of spinal stenosis, fibromyalgia, and back or neck pain, particularly where there is evidence of disc disease or disc herniation, stopping smoking is very important to increase chances of recovery and rehabilitation. This includes quitting cigarettes, cigars, pipes, and chewing tobacco. If the treatment plan for your spinal stenosis includes some kind of spinal surgery then using the preoperative period to wean yourself off nicotine will dramatically increase the success of surgery, helping you reduce your back pain and even banish it for good. Smoking and spinal stenosis back pain are connected, and those suffering will likely need to quit smoking to be considered for spinal surgery, highlighting the disadvantages of smoking for spine health.

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