Quit Smoking to Improve the Outcome of Your Spinal Fusion Surgery

My doctor has recommended spine surgery and says I have to stop smoking. Is this true—do I really have to stop? Can't I just cut back? I've been smoking for 15 years and know it will be very difficult to quit.
—New London, IAMale doctor breaking a cigarette in half
I know this may be hard for you to hear, but it really is true: it's absolutely necessary for you to quit smoking before your spine surgery.

This surgery could be just the motivation you need to really quit. Studies have shown that if you smoke, your spinal fusion is more likely to fail, meaning that you could end up back in the operating room. I'm guessing that you don't want to be there more than you have to.

As I explain below, it's best to quit entirely—not just cut back or even use a nicotine patch. That's because it's the presence of nicotine that ups your chances for infection, a failed fusion, or other complications.

What Smoking Does to Your Bones
Cigarette smoking inhibits bone health and growth. In general, smokers are less physically active than non-smokers, and exercise is vital to maintaining bone strength. Nicotine also decreases your body's blood circulation, making it harder for oxygen to get to various parts of your body. That means that your bones don't get the proper nutrition to grow.

How Smoking Affects Your Surgery
When you have a spinal fusion, the doctor will join bony segments (vertebrae) in your spine. Successful fusion of the bone results in a stable spine; conversely, failure of fusion may result in spinal instability. For the fusion to be successful, the bones have to actually fuse; new bone growth becomes a bridge for your vertebrae, providing stability. Sometimes, the doctor will use spinal instrumentation, like rods, screws, and wires, to help stabilize your spine. In these situations, failed fusion can cause this implanted instrumentation to loosen.

As I said above, nicotine inhibits bone growth, which puts you at a higher risk for a failed fusion (pseudoarthrosis). There are two main problems related to failed fusion:

  • Pain—patients with a failed fusion usually have some degree of pain due to spinal instability, and generally, it's a very bad pain. It could even be worse than the pain you were in before the surgery.
  • Possible revision of surgery in the future.

Smokers are also at a higher risk for infection because smoking weakens your body's natural defense mechanisms. Also, as mentioned before, smoking decreases your blood circulation, resulting in slower wound healing and an increased risk of infection. It's not as easy for you to fight infection, so you could end up back at the hospital needing antibiotics. You may even have to revisit the operating room to have the wound cleaned and drained.

How to Quit Smoking
I understand your concern about how difficult it will be to stop smoking. Fifteen years of a habit—good or bad—is a hard thing to break. In my experience with patients, a formal smoking cessation program works best because it gives you the motivation, accountability, and encouragement you need to overcome your addiction. You should also talk to your primary care physician about what would work best for you.

I am sure the decision to have spinal surgery was a difficult one, and I realize what a stressful time this is in your life. Therefore, you must want to do everything in your power to ensure a successful outcome, and the best way to do this is to quit smoking.

You already know that it will be tough to quit smoking. But for the sake of your back and your overall health, make today your first of many cigarette-free days.