Smoking as everyone knows by now causes multiple issues with your overall health.  Everyone knows about the common complications of smoking which include heart and lung disease.  However, what most patients down know about is how it affects your chances for a good surgical outcome.

There are three main ways smoking affects your back and neck health.  Almost everyone has heard of degenerative discs or “bulging discs”.  The discs are the shock absorbers of the spine.  They are used by the body to cushion the bones between the spine which are called the vertebre.  (see picture).   Everyone’s disc degenerate and collapse with time.  It is the main reason why we all get shorter as we age.  You have to think of the discs as jelly do-nuts.  With time (as we age) the do-nuts start to dry out and will collapse with gravity.  This is a normal process of aging that most people don’t notice until they are in their 60’s-70’s.  However, you can go through the process much earlier if you smoke.  Nicotine and the other by-products of smoking cause premature disc degeneration which leads to increased back pain at a younger age than patients who do not smoke.  Researchers have proven even in identical twins (same exact DNA) that the twin that smoked had a 20% higher rate of disc degeneration and pain associated with the degeneration compared to the non-smoking twin.

The last two ways that smoking affects your spine health is in regard to your recovery from neck or back surgery.  Smoking has multiple bad chemicals that are absorbed in the body that can lead to bad wound healing which include nicotine, carbon monoxide, and hydrogen cyanide.  Nicotine leads to vasoconstriction which leads to decreased blood flow to the wound that inhibits the regeneration of skin and soft tissues in your wound.  Think of vasoconstriction as turning off the water hose to your lawn in the summer.  If you did this your grass will dry up and die.  Same thing with regards to blood flow and wound healing.  Carbon monoxide displaces (pushes out) oxygen from your red blood cells which carry the all-important oxygen that is used by cells to heal tissues.  Lastly hydrogen cyanide also affects the metabolism of oxygen by the cells by inhibiting proteins that make the metabolism process proceed.

Lastly when you have a surgical fusion, which is sometimes used in in spine surgery, the goal is to have the two bones grow together.  This growth process is also inhibited by smoking and can lead to what is called a “nonunion” which is similar to having a broken bone and usually requires subsequently more spine surgery.   Research has shown that you have double the chance of having a nonunion when you smoke after spine surgery compared to those patients who don’t smoke following spine surgery.  The good news is even if you stop smoking just days before your surgery and don’t pick up a cigarette again after surgery your chance of nonunion is almost the exact same as a person who has never smoked in their life.