Adverse impact of smoking on the spine and spinal surgery

BACKGROUND: Tobacco smokers and companies are well aware that smoking increases the risks for cancers, vascular morbidity, and early mortality. This is a review of the plethora of adverse effects chronic smoking has on spinal tissues and spinal surgery. METHODS: Medline (PubMed) and Google Scholar databases were searched for pertinent literature through keywords related to smoking, spondylosis, and spinal surgery. RESULTS: Smoking accelerates spondylosis by impairing spinal tissue vascular supply through atherosclerosis and thrombosis, while inducing local hypoxia, inflammation, proteolysis, and cell loss. It, thus, compromises disc, cartilage, synovium, bone, and blood vessels. It can lead to early surgery, delayed wound healing, increased surgical site infection, failed fusion, more re-operations, and chronic spinal pain. CONCLUSION: There is ample evidence to support surgeons’ declining to operate on chronic smokers. The need for immediate and permanent smoking cessation and its potential benefits should be emphasized for the patient considering or who has undergone spinal surgery.