INTRODUCTION: The literature reports that cigarette smoking has a detrimental effect on the outcome of spinal fusion. This is thought to be due to its deleterious effects on microvascularization. However, there is also epidemiological evidence that smoking is a risk factor for chronic back pain, and it might therefore exert an effect on surgical outcome per se, simply as a negative lifestyle factor. This study examined the effects of smoking on the outcome of discectomy, where no bone healing is required.
METHOD: Inclusion criteria were: lumbar/lumbosacral disc herniation being treated with discectomy/sequestrectomy, no additional decompressive techniques or fusion/stabilization; German/English‐speaking. 282 patients participated; 236 had data on their smoking habits (categorized as non‐smoker; ≤5 cigarettes/day; 6‐10/day; 11‐15/day; 16‐20/day; >20/day). The patients completed the Core Outcome Measures Index (COMI) at baseline and 3, 12 and 24 months follow‐up; at follow‐up they also rated the global outcome of surgery.
RESULTS: 80/236 (33.9%) patients smoked. Baseline low back pain was significantly higher in smokers than non‐smokers (5.0±2.8 vs 4.1±2.8, respectively; p=0.04). No other baseline differences in COMI outcome domains were observed. The % good global outcomes (“operation helped a lot/helped”) were similar in the smokers and non‐smokers at every follow‐up: 87.2% vs 85.6%, respectively, at 3 months, (p=0.74); 85.2% v 85.0% at 12 months (p=0.97); and 87.2% v 85.7% at 24 months (p=0.81). There were no significant differences between the groups in the reduction in COMI score at any time‐point. The number of cigarettes smoked was unrelated to the change in COMI score.
CONCLUSION: The results corroborate the association between smoking and back pain, but indicate that cigarette smoking is not a negative risk factor for the outcome of discectomy. The findings support the notion that the effects previously reported for fusion are indeed related to the specific influence of smoking on bone healing.