How does being a smoker effect surgery or spine health?

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 don’t know, is how it affects your chances for a good surgical outcome.
There are three main ways smoking affects your back and neck health.  Some of you may have 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 vertebrae.  (see picture).   Over time, everyone has disc degeneration and collapse.  It is the primary reason why we all get shorter as we age.  Think of the discs as jelly-filled doughnuts.  With time (as we age), the “doughnuts” 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 in comparison to patients who do not smoke.  Researchers have proven that even in identical twins (same exact DNA), 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 smoking affects your spine health involve your recovery from neck or back surgery.  Smoking has multiple bad chemicals including nicotine, carbon monoxide, and hydrogen cyanide, which are absorbed in the body and can lead to poor wound healing.  Nicotine causes vasoconstriction which leads to decreased blood flow to the wound, inhibiting 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 further spine surgery to fix.   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.