The effect of smoking status and smoking cessation therapy on pseudarthrosis rates in spinal fusion
OA Version
Citation
Abstract
Cigarette smoking is a public health crisis in the United States and poses an increased risk for postoperative complications across many surgical specialties. The pathophysiologic effects of nicotine on bone health have been well elucidated and have led to an interest in the effects of smoking status and smoking cessation on procedures involving bone fusion, such as spinal fusion. Lumbar degenerative disc disease is the most common indication for this procedure, which serves to stabilize the spine and can be performed using different surgical approaches. Pseudarthrosis is a potential complication of spinal fusion that may be associated with smoking status and can lead to increased postoperative pain, disability, and reoperation. Although the relationship of nicotine on bone integrity has been established, the application of this knowledge to patients specifically undergoing spinal fusion who currently smoke or have a significant smoking history is still underway. In recent studies evaluating the effects of smoking status on fusion rate and clinical outcomes after lumbar spinal fusion, postoperative smoking cessation was found to significantly decrease nonunion rates compared to active smokers. Additional studies showed that the use of any form of nicotine replacement therapy was associated with significantly decreased odds of developing any postoperative complication, but not pseudarthrosis specifically. Only one study to date has utilized an animal model to evaluate the independent effects of varenicline, a nicotine replacement, on spinal fusion outcomes and demonstrated that varenicline does not negatively interfere with the process of bone fusion. The proposed retrospective cohort study aims to analyze the development of radiographic pseudarthrosis following lumbar spinal fusion for the treatment of degenerative disc disease in nonsmokers, smokers treated with varenicline perioperatively, and active smokers not treated with varenicline perioperatively. If the results of this study demonstrate a decreased rate of pseudarthrosis in patients receiving varenicline perioperatively, perioperative guidelines for providers to prescribe appropriate smoking cessation therapy to patients undergoing spinal fusion may be better defined and healthcare costs associated with the treatment of pseudarthrosis will be improved. This study also has the potential to guide further research prospectively evaluating the use of varenicline and other smoking cessation therapies in patients undergoing spinal fusions.
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2024