Spinal Fusion More Successful in Nonsmokers

For Immediate Release

For more information, contact:Joanne L. Swanson(847) 384-4035 [email protected]

A.J. Wright(847) 384-4034 [email protected]

Todd Schuetz(847) 384-4032 [email protected]

SPINAL FUSION MORE SUCCESSFUL IN NONSMOKERS, NEW STUDY FINDS

ROSEMONT, Ill.-- Smoking has a significantly negative impact on healing and recovery from cervical spine fusion, according to a new study published in the Journal of Bone and Joint Surgery (JBJS), Volume 83-A, Number 5.

Spinal fusion outcomes of patients with cervical (neck) disk disorders are better in nonsmokers, said study co-author Alan S. Hilibrand Jr., MD, assistant professor of orthopaedic surgery, Thomas Jefferson University and Rothman Institute, Philadelphia.

"Cervical spine patients who smoke have more pain than nonsmokers following surgery and they require more pain medication," said Dr. Hilibrand, who also serves as adjunct professor, department of mechanics and mechanical engineering, Drexel University, Philadelphia.

"Smoking creates a biologically-challenging environment in which spinal fusion is less likely to succeed," he said. "Nicotine has been shown to have a direct negative affect on bone graft healing."

For two- to 15 years, Dr. Hilibrand and colleagues studied 190 cervical disk patients at the University Hospitals Spine Institute and the department of orthopaedic surgery, Case Western Reserve University School of Medicine, Cleveland. The patients had been treated for disk herniation or spondylosis, an excess bone formation around spinal disks. The two conditions are characterized by neck pain radiating down the arm.

Results of the study show that nonsmokers achieved a significantly higher rate (81 percent) of solid osseous (bone) union than the 62 percent rate among smokers.

As for clinical results, which include pain level, need for pain medication, and ability to perform activities of daily living, nonsmokers fared better than smokers did. "Fully 88 percent of the nonsmokers had good or excellent clinical results compared to 76 percent of smokers," said Dr. Hilibrand, who noted that patients with a nonunion, or failure of fusion, will often need an additional surgical procedure. "The findings also show that smokers' daily activity levels are lower than nonsmokers."

For the study, the researchers compared the clinical outcomes of patients who had a solid fusion with those of patients who developed a nonunion. Among the 142 patients whose spinal fusion resulted in a solid union, 68 had excellent, 63 good, 11 fair and no one had poor outcomes from the surgery.

"In contrast, five of the 48 patients with a nonunion had excellent outcomes; 26 good, 14 fair and three poor outcomes," said Dr. Hilibrand. "Smokers' poorer clinical outcomes were associated with this group's lower rate of fusion."

Although most common among people in their early 50s, cervical disk disorders are seen in people in their 20s through people in their 80s. More than 100,000 cervical spine fusions are performed in the U.S. each year.

"In order for a cervical spine problem to have the best possible outcome from the surgery," said Dr. Hilibrand, "it is very important that the patient stop smoking in the weeks prior to the surgery date.

"Research already has shown that cigarette smoking leads to lower healing rates for spinal fusion in the lower back," noted Dr. Hilibrand. "But this is the first study to show its impact on cervical spine fusion. Smoking is also associated with increased incidence of fractures; delays in fracture healing and decreased bone mass.

Co-authors of the study with Dr. Hilibrand, are Mark A. Fye, MD, Sanford E. Emery, MD, and Henry H. Bohlman, MD, from University Hospitals Spine Institute, Cleveland; and Mark A. Palumbo, MD, University Orthopaedics, Incorporated, Providence, R.I.

An orthopaedic surgeon is a medical doctor with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, muscles and nerves.

The Journal of Bone and Joint Surgery (JBJS) is the official scientific publication of the 25,500-member American Academy of Orthopaedic Surgeons (www.aaos.org) or (http://orthoinfo.aaos.org), a not-for-profit organization which provides educational programs for orthopaedic surgeons, allied health professionals and the public.

Dr. Hilibrand is a member of the Academy. The Academy's Position Statement, Smoking and the Musculoskeletal System, is available online at: http://www.aaos.org/wordhtml/papers/position/smoking.htm.

The peer-reviewed JBJS, located in Needham, Mass., is published monthly. Abstracts are available online at http://www.jbjs.org

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