Surgery Spine Stabilization & Smoking

Spine Surgery and Cigarette Smoking

Its hard to say anything good about cigarette smoking from the medical standpoint. Smoking places nicotine and carbon monoxide into the blood stream and then into body tissues. These poisons have a particularly high deleterious effect on the cells of the intervertebral discs because of their precarious nutritional status. This situation is even more grim when the endplates are congenitally abnormal (as in the genomic spine disorder juvenile discogenic disease). Because of their avascular structure discs are more vulnerable to being poisoned than other body tissues. Researchers have found that smokers carry a 3-4x higher risk of disc degeneration than in non-smokers. This risk is significantly higher in individuals with underlying genomic spine disorders. In addition smoking greatly increases the failure rate in instrumented procedures associated with bone grafting, such as pedicle screw instrumentation. Many astute spine surgeons now require that patients become non-smokers before they will consider them as surgical candidates.

Courtesy Orthofix, Inc.

The key reason for failure of surgical stabilization procedures utilizing the patient's own bone for grafting (worse if the bone isn't autologous) is the adverse effect of toxic materials, such as nicotine and carbon monoxide on body tissues. These toxins are particularly damaging to the ability of the body to create a neo-vascular network to serve as a highway for osteoblasts which are attempting to lay down new bone (osteoneogenesis).

The illustration above demonstrates what happens when bone graft (green) is placed in proximity to normal body bone (yellow). Bleeding creates a hematoma (#4) in which cartilage begins to form (white spots). While old bone in the graft is being broken down by scavenger cells (osteoclasts #1), osteoblast cells migrate from normal bone to the graft and "set up shop" in the zone where the osteoblasts have been at work. The key to this process occurring is the fine new vascular network (neovascularity) created by the body (#2). It is the neovascular structures which are the most sensitive to toxic materials in their environment. Without this bridge the osteoblasts loose their opportunity to travel to the graft.

Attempting to becoming a non-smoker (and maintaining this) is clearly one of the greatest challenges that an individual can face during their lifetime. Patients have pointed out that it was easier for them to get off of "crack cocaine" than it was for them to quit smoking. Fortunately, there are many resources presently available in the community for self-help and good reference material is available for review.

Shown above is a Special Issue of the Journal Vibrant Life (Box 1119, Hagerstown, MD 21741; 1-800-765-6955).