Smoking as an independent predictor of reoperation after lumbar laminectomy: a study of 500 cases

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>This study aimed to identify the factors predicting an increased risk for reoperation in patients who had undergone a lumbar laminectomy.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors retrospectively reviewed the electronic medical records of all patients who had undergone firsttime, bilateral laminectomy at 1, 2, or 3 levels for lumbar spondylosis at the authors' institution. Patients who underwent fusion, laminotomy, discectomy, or complete facetectomy were excluded. The patients' preoperative symptoms and comorbidities were also obtained from their medical records.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Over an average follow-up period of 46.8 months, of 500 patients who had undergone laminectomy at 1, 2, or 3 levels, 81 patients (16.2%) developed subsequent spinal disorders that required a reoperation. A multiple logistic regression analysis identified smoking as an independent predictor of reoperation (OR 2.15, p = 0.01). Smoking was also an independent predictor of reoperation after a single-level laminectomy (OR 11.3, p = 0.02) and after a multilevel (that is, involving 2 or 3 levels) laminectomy (OR 1.98, p = 0.05). For 72 patients undergoing reoperation only for spinal degeneration, smoking remained an independent, statistically significant predictor of reoperation (OR 2.06, p = 0.04). Nine patients underwent reoperation for nondegenerative conditions (hematoma, wound infection, or wound dehiscence), and in these patients, chronic obstructive pulmonary disease was the only statistically significant predictor of reoperation (OR 8.92, p = 0.03).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Smoking was the strongest predictor of reoperation in patients who had undergone single-level laminectomy, multilevel laminectomy, or reoperation for progression of spinal degeneration. These findings suggest that smokers have worse outcomes of lumbar decompression than nonsmokers.</jats:p></jats:sec>

Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion Using Triangular Titanium Implants vs Nonsurgical Management for Sacroiliac Joint Dysfunction

“…Smokers are known to have higher reoperation rates after lumbar laminectomy 58 and lower fusion rates after lumbar fusion. 59 , 60 In our study, they exhibited somewhat smaller improvements in SIJ pain and ODI, but these differences were not statistically significant. Although smoking may impair bone growth onto titanium implants, 61 , 62 the effect appeared to be minor.…”

Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

“…4 A separate study demonstrated higher rates of reoperation among smokers receiving a single-or multiple-level laminectomy. 6 Similar results have also been noted for minimally invasive spine surgery. Gulati et al reported decreased improvement in patient Oswestry Disability Index (ODI) scores at 1 year among smokers relative to nonsmokers following microdecompression for lumbar spinal stenosis.…”

The Effects of Smoking and Smoking Cessation on Spine Surgery: A Systematic Review of the Literature

“…This smoking-related disk degeneration provides a likely explanation for the higher rates of recurrent or adjacent-level disease requiring reoperation observed in numerous studies. 31 32 33 34 35 Nicotine is also a central pain-modulating agent and individuals with higher rates and intensity of spine-related pain may be predisposed to addiction to help mitigate their symptoms. 6 36 37 38 Finally, the higher incidence of depression among smokers predisposes this population to increased back-related disability, which could negatively affect postoperative outcome measures.…”