By Brad Curt, MD
As a neurosurgeon and spine specialist, I am keenly aware of how tobacco use negatively impacts all aspects of your health and, specifically, your spine. This holds true whether you are facing spine surgery or whether – at this moment — your back is giving you no trouble at all.
Smoking reduces blood flow
Smoking increases degeneration of the body. With that first puff of smoke, nicotine begins to create vasoconstriction. It acts on the receptors on your blood vessels, causing them to narrow and contract. This, in turn, causes blood flow to your body to slow down.
Those blood vessels provide vital nutrition to your body, including the discs, joints, and ligaments in your back. Starving your body of this nutrition leads to faster degeneration and reduced healing. So if you’re someone who smokes, you have – or will someday have — more back pain than a non-smoker. Smoking also tends to make people less active, which leads to a more sedentary lifestyle, which also increases back pain.
Smoking weakens bones
When vasoconstriction decreases blood flow and deprives a smoker’s body of vital nutrition, it leads to increased osteoporosis rates. The risk of osteoporosis is heightened as well by the loss of exercise capacity that smoking imposes. If you’re not moving, your bones will get weaker over time. With osteoporosis, there is not only an increased risk of degeneration, there is also an increased risk of fractures in the spine, fwhich we see all the time. Mayfield surgeons treat well over a hundred spinal fractures caused by osteoporosis every year.
Smoking suppresses the building of new bone
It is well documented that smoking interferes with healing from any injury or surgery. We know that rates of healing and infection are worse for smokers than non-smokers. This occurs because reduced blood flow cannot bring sufficient nutrition and healing products to the area that is trying to recover.
This is especially true for patients who undergo spinal fusion, a surgery that joins one or more vertebrae. During fusion, new bone is being created, and that new bone is sitting typically in a space that doesn’t get good blood flow in the best of circumstances. So if you have a little oasis in the desert and you deprive that oasis of what little water it’s going to get, then, unfortunately, the fusion material tends to die in what is called a “pseudarthrosis,” or non-fusion. If your vertebrae don’t fuse, you’re at a higher risk of having chronic back pain or a less successful surgery.
Helping my patients quit
I have great empathy for my patients who smoke. I know that it is extremely difficult to quit. Smoking is very addictive, both physically and psychologically. My patients and I talk about switching to a non-nicotine vapor as a transition; we talk about using medications like Chantix®. Some patients will work with a hypnotist. I explain why smoking is bad for their general health as well and how it may negatively impact their outcome if they are undergoing surgery.
Vaping is not a substitute for smoking. Because it contains nicotine, vaping has the same vasoconstrictive effect as smoking tobacco. In fact, some reports indicate that vaping is just as addictive or more so because of tastes and flavors that many people find pleasurable.
Increasingly, quitting may not be optional
Recently, I have begun telling my patients who need a fusion that they really must quit before surgery. There are certainly emergency situations where this is not possible. We have no choice but to operate if the patient is experiencing paralysis or they’re going to lose significant function. In these situations we may use special mechanisms or techniques to augment and improve the rate of fusion. But generally I tell my patients that they have to quit for 4 to 6 weeks before surgery. Because if you don’t heal well, you’re not going to do well. In fact, I recently canceled a surgery for a patient who had not yet quit. We will reschedule this particular surgery once the patient has been able to quit.
Insurance companies lower the boom
Meanwhile, many insurance companies are now requiring patients to have quit smoking for 6 weeks before surgery. Insurers reason that if the surgery doesn’t go as planned and the patient doesn’t heal, then they pick up the cost of the patient’s chronic conditions. At Mayfield, we have had insurance companies deny the procedure until the patient has been able to document, with a mouth swab or blood test, that they have been able to quit smoking.
Fusion takes a year to heal
After fusion, ideally for your own health and well-being, you should quit permanently and never re-start. Unfortunately, some patients quit for the required period before their fusion surgery and then start smoking again afterwards. This is always disheartening. During fusion, you’re growing brand new bone, and it generally takes a full year for that bone to become solid. When patients start smoking any time during that healing process, they potentially put their fusion at risk. You can’t just commit for a few weeks and think it’s going to be OK.
Cheering for you
To smokers everywhere who are trying to quit, my colleagues and I are pulling for you. We want you to enjoy optimal health and well-being. And if you are a surgery candidate, we want your outcome to be a success. We support you in your efforts to have a healthy spine — the backbone of a healthy life.
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Brad Curt, MD, is a board-certified neurosurgeon with Mayfield Brain & Spine.
He sees patients at Mayfield’s office in West Chester, Ohio.
Resources
1. Ohio Department of Health / Tobacco Cessation
2. Ohio Tobacco Quit Line: 1-800-QUIT-NOW
3. Quit Now Kentucky: 1-800-QUIT-NOW