Smoking, Tobacco Use, e-Cigarettes and Spine Surgery

Whether you smoke cigarettes, e-cigarettes (electronic cigarettes), use other types of tobacco or not—you will be interested in what five spine surgeons had to say. SpineUniverse asked five of its Editorial Board members—orthopaedic spine surgeons and neurosurgeons—questions about tobacco use, vaping and spinal surgery.

The questions we asked:

• What do spine surgeons tell their patients who smoke cigarettes, use other types of tobacco, and/or vape?
• Do you consider e-cigarettes similar to other nicotine-related products?
• Why are people who smoke at greater risk for back pain and potentially increased risk during and after spine surgery? How does this affect your decision to perform surgery?

What do you tell your patients who smoke cigarettes, use other types of tobacco, and/or vape?

Lali Sekhon, MD, PhD, FACS, FAANS — Neurosurgeon
Smoking accelerates degenerative disc disease. If spinal surgery is performed, the outcomes are impaired. Anesthesia is more challenging and spinal fusions are less likely to heal. Patients can’t stop smoking if others in the family continue to smoke, so spouses/partners need to stop at the same time. Nicotine is the culprit, so nicotine patches and gums are to be avoided if fusion surgery is to be performed. I suggest patients talk to their primary care physician. Options, such as Chantix, hypnosis, acupuncture, and even laser therapy are used. Often smokers need to try to stop smoking many times in order to succeed. Cutting down is also better than nothing.

Do physicians consider e-cigarettes similar to other nicotine-related products?

Lali Sekhon, MD, PhD, FACS, FAANS — Neurosurgeon
Probably. Nicotine impairs fusion healing.

Why are people who smoke at greater risk for back pain and potentially increased risk during and after spine surgery? How does this affect your decision to perform surgery?

Lali Sekhon, MD, PhD, FACS, FAANS — Neurosurgeon
Surrounding bone delivers necessary oxygen to the discs’ cartilage cells (chondrocytes). In smokers, the oxygen level drops and the cells die. Oxygen is also necessary for the production of cells that hold water inside the discs (glycosaminoglycans). When glucosaminoglycan cells die, the discs dry out, degenerate and become prone to cracking—all of which accelerates wear and tear, and may lead to chronic back pain.