Smoking Reduces Surgical Improvement for Cervical Myelopathy Interview with:

Dr. David Kusin MD University of Nebraska Medical Center Omaha

Dr. David Kusin

Dr. David Kusin MD
University of Nebraska Medical Center
Omaha What is the background for this study? What are the main findings?

Response: There is a wealth of research showing that cigarette smoking impairs healing through various mechanisms, including microvascular injury. Some evidence also suggests that tobacco use results in direct neurological injury to the peripheral and central nervous systems. Many studies have also shown that smoking reduces fusion rates and time to fusion in orthopedic surgery, including cervical surgery. Prior to our work, only a few high quality studies had been conducted to investigate prognostic factors in patients undergoing surgery for cervical myelopathy, and these identified smoking as a risk factor for a poorer outcome. The purpose of our study was to investigate this relationship further.

We conducted a retrospective cohort study of 87 nonsmokers and 47 smokers and correlated postoperative change in Nurick score (a measure of severity of cervical myelopathy from 0-5 with 5 being the worst) with smoking status. After controlling for age, sex, diabetes, duration of preoperative symptoms, severity of preoperative symptoms, signal change on MRI, surgical approach, number of spinal levels operated on, and alcohol use, we found that smokers had a significantly decreased improvement in Nurick score. Nonsmokers improved by 1.5 points whereas smokers only improved by 0.6 points. We also found that this was a dose response relationship, such that those with a history of greater tobacco use by pack years or packs per day had a greater decrease in improvement postoperatively. Interestingly, we found no correlation between tobacco use and preoperative severity of symptoms. What should readers take away from your report?
Response:  This work underscores the importance of discussing smoking cessation with all patients who are planning to undergo surgery. What recommendations do you have for future research as a result of this study?

Response: It would be interesting to repeat this study with a larger cohort and stratify results according to current, former, and never smokers to see if former smokers continue to have an increased risk of poorer outcomes compared to those who had never smoked, or whether they reach the same level of risk as never smokers, and how long it takes after quitting to reach a maximally reduced risk. I suspect that quitting does reduce the risk of a poorer outcome, but not to the level of those who had never smoked, and that the time to maximally reduced risk in quitters would also be dependent upon the number of pack years the patient had smoked. Thank you for your contribution to the community.

Citation: Abstract presented at the 2016 NASS meeting October 2016

The Effect of Smoking on Spinal Cord Healing following Surgical Treatment for Cervical Myelopathy
David Kusin, MD; Nicholas U. Ahn, MD

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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