Are stronger pre-surgical smoking cessation programs needed? Zorica Buser, PhD, and Jeffrey C. Wang, MD, comment on the study findings.
Researchers found yet another reason to quit smoking: Patients with cervical degenerative disc disease (DDD) with tobacco use disorder (TUD) had spine surgery more often—and at a younger age—than patients who do not smoke. The findings were published in the May 2017 issue of the European Spine Journal.
“Although our study did not look at the progression of cervical degenerative conditions, our results indicate that smoking has a potential impact on the onset and severity of spine pathologies ultimately leading to a need for surgical treatment at a younger age,” said co-authors Phillip Grisdela Jr., BA, Zorica Buser, PhD, and Jeffrey C. Wang, MD, of the University of Southern California.
Tobacco Use Disorder and Cervical Disc Disease: A Growing Problem
The authors used the Humana insurance corporation’s database to identify patients who had cervical disc degeneration with or without myelopathy between 2007 and 2013.
The prevalence of disc degeneration with myelopathy increased by 32.8% between 2007 and 2013, while disc disease with myelopathy and TUD rose by 91.6%. For patients without myelopathy, the prevalence of disc degeneration alone increased by 65.4%, with a 148.7% increase in the number of patients with TUD.
“The awareness on negative impact of smoking on overall health is huge; however, it was surprising to see that the incidence of patients with tobacco use disorder and cervical DDD with or without myelopathy was increasing over years and doubling in numbers between 2007 and 2013.”
Previous TUD diagnosis was associated with increased rates of cervical spine surgery—in fact, patients diagnosed with TUD and cervical DDD were more than twice as likely to have surgery than those who did not have TUD.
Of myelopathy patients, 1,717 (6.4%) had TUD and 1,024 (59.6%) received surgery, compared to 6,508 patients without TUD (26.1%). For patients without myelopathy, 11,337 (3.5%) had TUD and 787 (6.9%) underwent surgery, compared to 9,716 patients (3%) without TUD.
Are Stronger Pre-Surgical Smoking Cessation Programs Needed?
Despite evidence of smoking’s adverse effects on spine surgery recovery, the research team found that 781 (76.3%) surgical patients with myelopathy and TUD still had a TUD diagnosis at surgery, and 542 (68.9%) of patients without myelopathy had TUD at surgery, indicating that most patients did not quit smoking between the time they were diagnosed with cervical DDD and their procedure.
“Studies have shown that those who smoke at the time of surgery are at a higher risk of post-operative complications and infections as well as lower outcome scores and return to work/recovery rates,” wrote the authors. “As a result, it is commonly recommended that smoking patients quit smoking at least 4–6 weeks before surgery and during recovery.
The authors surmise that the high amount of patients who did not quit smoking prior to surgery indicate, “The need for either more aggressive smoking cessation aids or more restrictive patient selection when it comes to those with TUD.”
Main Takeaway for Spine Specialists
The study results identified a growing incidence of TUD and cervical disc disease, which Buser and Wang said begs additional studies, particularly well-designed prospective multicenter longitudinal studies focusing on both conservative and surgical treatments in patients with a history of smoking. Studies looking at the outcomes and complications after surgery, as well as smoking cessation, are also needed.
Drs. Buser and Wang indicated that whether a patient smokes or not should play a pivotal role in the treatment spine specialists recommend.
“Smoking is among the top preventable causes of various medical conditions and death,” they said. “The smoking status should be taken into consideration during treatment planning, especially in patients with other co-existing risk factors or conditions.”
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Grisdela Jr. P, Buser Z, D’Oro A, Paholpak P, Liu JC, Wang JC. Trends analysis of surgical procedures for cervical degenerative disc disease and myelopathy in patients with tobacco use disorder. Eur Spine J. 2017; 26:2386–2392. doi: 10.1007/s00586-017-5120-9.