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The Effect of Cigarette Smoking and Smoking Cessation on Spinal Fusion

Glassman, Steven D., MD*‡; Anagnost, Steven C., MD*; Parker, Andrew, MD*; Burke, Darlene, MA; Johnson, John R., MD*‡; Dimar, John R., MD*‡

Clinical Case Studies

Study Design. The effect of cigarette smoking and smoking cessation on spinal fusion was studied in a retrospective review of 357 patients who had undergone instrumented spinal fusion.

Objective To document the widely assumed but unreported benefit of cigarette smoking cessation on fusion rate and clinical outcome after spinal fusion surgery.

Background Data. Cigarette smoking has been shown to inhibit lumbar spinal fusion and to adversely effect outcome in treatment of lumbar spinal disorders. Prior reports have compared smokers and nonsmokers, as opposed to comparing smokers and quitters.

Methods. This study retrospectively identified 357 patients who underwent a posterior instrumented fusion at either L4–L5 or L4–S1 between 1992 and 1996. Analysis of the medical record and follow-up telephone surveys were conducted. Clinical outcome and fusion status was analyzed in relation to preoperative and postoperative smoking parameters.

Results. In this study, the nonunion rate was 14.2% for nonsmokers and 26.5% for patients who continued to smoke after surgery (P < 0.05). Patients who quit smoking after surgery for longer than 6 months had a nonunion rate of 17.1%. The nonunion rate was not significantly affected by either the quantity that a patient smoked before surgery or the duration of preoperative smoking abatement. Return-to-work was achieved in 71% of nonsmokers, 53% of nonquitters, and 75% of patients who quit smoking for more than 6 months after surgery.

Discussion. These results validate the hypothetical assumption that postoperative smoking cessation helps to reverse the impact of cigarette smoking on outcome after spinal fusion.

From the Departments of *Orthopaedic and †Neurological Surgery, University of Louisville School of Medicine, and the ‡Kenton D. Leatherman Spine Center, Louisville, Kentucky.

Acknowledgment date: August 26, 1999.

First revision date: November 1, 1999.

Acceptance date: December 13, 1999.

Address reprint requests to

Steven D. Glassman, MD

Spine Institute for Special Surgery, PSC

210 E. Gray St, Suite 900

Louisville, KY 40202


Device status category: 1.

Conflict of interest category: 12.

© 2000 Lippincott Williams & Wilkins, Inc.