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Impact of Smoking on Complication and Pseudarthrosis Rates After Single- and 2-Level Posterolateral Fusion of the Lumbar Spine

Bydon, Mohamad, MD*,†; De la Garza-Ramos, Rafael, MD*,†; Abt, Nicholas B., BS*,†; Gokaslan, Ziya L., MD*,†; Wolinsky, Jean-Paul, MD*,†; Sciubba, Daniel M., MD*,†; Bydon, Ali, MD*,†; Witham, Timothy F., MD*,†

doi: 10.1097/BRS.0000000000000527
Clinical Case Series

Study Design. Retrospective study.

Objective. To study the impact of smoking status on postoperative complications and pseudarthrosis in adult patients undergoing posterolateral fusion (PLF) of the lumbar spine.

Summary of Background Data. Results of studies analyzing the impact of smoking on complication and pseudarthrosis rates after spine surgery are conflicting.

Methods. A retrospective medical record review was performed to identify all adult patients who underwent single- and 2-level instrumented PLF without interbody devices for degenerative spine disease in a 21-year period at a single institution. Patients were divided into smokers and nonsmokers. The main outcome variables were development of at least one postoperative complication and development of pseudarthrosis.

Results. A total of 281 patients underwent single- or 2-level PLF in the 21-year period. Of these, 231 (82.21%) patients were nonsmokers and 50 (17.9%) were smokers. For patients undergoing single-level PLF, complication rates in nonsmokers (3.57%) versus smokers (7.69%) were not significantly different (P = 0.353); pseudarthrosis in nonsmokers occurred in 9.82% of cases compared with 7.69% in the smokers group (P = 0.738). Nonsmokers undergoing 2-level PLF had complication rates of 6.72%, compared with 4.17% in smokers (P = 0.638), but pseudarthrosis rates were significantly higher in the smokers group than in the nonsmokers group (29.17% vs. 10.92%; P = 0.019). Patients were followed up for an average of 53.5 months.

Conclusion. The findings in this study suggest that smoking has a significant impact on pseudarthrosis rates after 2-level PLF of the lumbar spine, but not necessarily on single-level PLF.

Level of Evidence: 4

The impact of smoking on complication and pseudarthrosis rates after spinal surgery has been subject to research, but results are conflicting. In this study, only smokers undergoing 2-level posterolateral fusion of the lumbar spine had significantly higher pseudarthrosis rates than nonsmokers; smoking made no impact on single-level fusion.

*The Spinal Column Biomechanics and Surgical Outcomes Laboratory and

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Timothy F. Witham, MD, The Johns Hopkins Hospital, 600 North Wolfe St, Meyer 7-109, Baltimore, MD 21287; E-mail:

Acknowledgment date: February 17, 2014. First revision date: May 6, 2014. Acceptance date: July 14, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, stocks, travel/accommodations/meeting expense.

© 2014 by Lippincott Williams & Wilkins