The influence of smoking in minimally invasive spinal fusion surgery

Abstract

Background The impact of smoking on spinal surgery has been studied extensively, but few investigations have focused on minimally invasive surgery (MIS) of the spine and the difference between complication rates in smokers and non-smokers. We evaluated whether a history of at least one pack-year preoperatively could be used to predict adverse peri- and postoperative outcomes in patients undergoing minimally invasive fusion procedures of the lumbar spine. In a prospective study, we assessed the clinical effectiveness of MIS in an unselected population of 187 patients. Methods We evaluated perioperative and postoperative complication rates in MIS fusion techniques of the lumbar spine in smoking and non-smoking patients. MIS fusion was performed using interbody fusion procedures and/or posterolateral fusion alone. Results Smokers were significantly younger than non-smokers. We did not encounter infection at the site of surgery or severe wound healing disorder in smokers. We registered no difference between the smoking and non-smoking groups with regard to peri- or postoperative complication rate, blood loss, or length of stay in hospital. We found a significant influence of smoking (p = 0.049) on the overall perioperative complication rate. Conclusion MIS fusion techniques seem to be a suitable tool for treating degenerative spinal disorders in smokers.

The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis

“…Fourteen studies (82%) were conducted in the United States 15,16,[25][26][27][28][29][30][32][33][34]36,38,39 one in Australia, 35 one in Germany 31 and one in Austria. 37 Of the 37 897 participants, 10 031 (26.5%) were smokers and 27 866 (73.5%) were nonsmokers. The mean age for the study population was 58 years, and 45% were males.…”

“…A total of 5727 titles/ abstracts were screened and, after removing 333 duplicates, 33 full texts were evaluated for study inclusion. Seventeen studies 15,16,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] assessing 37 897 participants met inclusion criteria, Figure 1. Articles excluded at full-text review and reason for exclusion are listed in Supplementary Material, Supplementary Table S4.…”

“…Four studies assessed the effect of smoking on adverse events in the cervical spine, 28,32,36,38 ten in the thoracolumbar spine, 16,[25][26][27]30,31,[33][34][35]37 and three in both the cervical and thoracolumbar spine. 15,29,39 In nine studies, the approach was only posterior, 16,[25][26][27][28][29]31,33,37 in three only anterior, 35,36,38 and in five, a mix of posterior and/or anterior and/or combination of both approaches. 15,30,32,34,39 The number of levels fused varied between 1 and 23, Table 3.…”

“…Four studies were judged as good-quality, 16,27,34,39 five as fairquality 15,25,29,32,35 and eight as poor-quality studies. 26,28,30,31,33,[36][37][38] The concerns about bias in the studies were primarily related to three domains: outcome measurement, lack of control for confounding, and high or uncertain study attrition.…”