Abstract
The aim of this study was to evaluate the influence of smoking on the outcome of patients undergoing surgery for degenerative spinal diseases, and to examine whether smoking had a differential impact on outcome, depending on the fusion technique used. The cohort included 120 patients treated with two different fusion techniques (translaminar screw fixation and TLIF). They were categorised with regard to their smoking habits at the time of surgery and completed the Core Outcome Measures Index at baseline and follow-up (FU) (3, 12 and 24 months FU); at FU they also rated the global outcome of surgery. The distribution of smokers was comparable in the two groups. For the TS group, the greater the number of cigarettes smoked, the less the reduction in pain intensity from pre-op to 24 months FU; the relationship was not significant for the TLIF group. The percentage of good global outcomes declined with time in the TS smokers such that by 24 months FU, there was a significant difference between TS smokers and TS-non-smokers. No such difference between smokers and non-smokers was evident in the TLIF group at any FU time. In conclusion, the TS technique was more vulnerable to the effects of smoking than was TLIF: possibly the more extensive stabilisation of the 360° fusion renders the environment less susceptible to the detrimental effects on bony fusion of cigarette smoking.
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References
Read RC (1984) Presidential address. Systemic effects of smoking. Am J Surg 148(6):706–711
Krupski WC (1991) The peripheral vascular consequences of smoking. Ann Vasc Surg 5(3):291–304
Silcox DH, IIIrd et al. (1995) The effect of nicotine on spinal fusion. Spine (Phila Pa 1976) 20(14):1549–1553
Blumenthal SL et al (1988) The role of anterior lumbar fusion for internal disc disruption. Spine (Phila Pa 1976) 13(5):566–569
Brown CW, Orme TJ, Richardson HD (1986) The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine (Phila Pa 1976) 11(9):942–943
Hanley EN Jr, Levy JA (1989) Surgical treatment of isthmic lumbosacral spondylolisthesis. Analysis of variables influencing results. Spine (Phila Pa 1976), 14(1):48–50
Daftari TK et al (1994) Nicotine on the revascularization of bone graft. An experimental study in rabbits. Spine (Phila Pa 1976) 19(8):904–911
Hollo I, Gergely I, Boross M (1977) Smoking results in calcitonin resistance. JAMA 237(23):2470
de Vernejoul MC et al. (1983) Evidence for defective osteoblastic function. A role for alcohol and tobacco consumption in osteoporosis in middle-aged men. Clin Orthop Relat Res (179):107–115
Glassman SD et al (2000) The effect of cigarette smoking and smoking cessation on spinal fusion. Spine (Phila Pa 1976) 25(20):2608–2615
Andersen T et al (2001) Smoking as a predictor of negative outcome in lumbar spinal fusion. Spine (Phila Pa 1976) 26(23):2623–2628
Woertgen C et al (1997) Does the choice of outcome scale influence prognostic factors for lumbar disc surgery? A prospective, consecutive study of 121 patients. Eur Spine J 6(3):173–180
Manniche C et al (1994) Analysis of preoperative prognostic factors in first-time surgery for lumbar disc herniation, including Finneson’s and modified Spengler’s score systems. Dan Med Bull 41(1):110–115
Weir BK (1979) Prospective study of 100 lumbosacral discectomies. J Neurosurg 50(3):283–289
Magerl F, WB (1985) Translaminäre Verschraubung der Intervertebralgelenke. Springer, Berlin, pp 315–317
Aepli M, Mannion AF, Grob D (2009) Translaminar screw fixation of the lumbar spine: long-term outcome. Spine (Phila Pa 1976) 34(14):1492–1498
Tuli J et al (2007) A comparison of long-term outcomes of translaminar facet screw fixation and pedicle screw fixation: a prospective study. J Neurosurg Spine 7(3):287–292
Grob D et al (2009) A prospective, cohort study comparing translaminar screw fixation with transforaminal lumbar interbody fusion and pedicle screw fixation for fusion of the degenerative lumbar spine. J Bone Joint Surg Br 91(10):1347–1353
Grob D, Humke T (1998) Translaminar screw fixation in the lumbar spine: technique, indications, results. Eur Spine J 7(3):178–186
Humke T et al (1998) Translaminar screw fixation of the lumbar and lumbosacral spine. A 5-year follow-up. Spine (Phila Pa 1976) 23(10):1180–1184
Mannion AF et al (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14(10):1014–1026
Deyo RA et al (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23(18):2003–2013
Ferrer M et al (2006) Validation of a minimum outcome core set in the evaluation of patients with back pain. Spine (Phila Pa 1976) 31(12):1372–1379 (discussion 1380)
Mannion AF et al (2007) Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol 3(11):610–618
White P, Lewith G, Prescott P (2004) The core outcomes for neck pain: validation of a new outcome measure. Spine (Phila Pa 1976) 29(17):1923–1930
Anjarwalla N, Morcom RK, Fraser RD (2006) Supplementary stabilization with anterior lumbar intervertebral fusion—a radiologic review. Spine (Phila Pa 1976) 31(11):1281–1287
Warner DO (2007) Tobacco dependence in surgical patients. Curr Opin Anaesthesiol 20(3):279–283
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Luca, A., Mannion, A.F. & Grob, D. Should smoking habit dictate the fusion technique?. Eur Spine J 20, 629–634 (2011). https://doi.org/10.1007/s00586-010-1594-4
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DOI: https://doi.org/10.1007/s00586-010-1594-4