The Impact of Smoking on Spine Health and Surgery Outcomes

Spine-health probably isn’t the first thing that comes to mind when you think of the harms of smoking. However, smoking may cause spine problems, including osteoporosis and poor outcomes after back surgery.

“The spine is a central structural component in the body,” says Shalin Shah, D.O., an orthopedic surgeon in Aberdeen, New Jersey. “Any compromise of the spine, whether to the bones, muscles or the discs, can lead to accelerated degeneration and chronic pain.” 

The Effects of Smoking on the Spine

Smoking negatively impacts spinal health in several ways:

Disc Damage

Your spine's discs act as cushions between the vertebrae, absorbing shock. Smoking accelerates the breakdown of these discs, which can lead to:

• Reduced cushioning and increased instability
• Pain
• Chronic back conditions
  
  

Osteoporosis Risk

• Smoking decreases bone density, increasing the risk of osteoporosis.
• This results in weaker, more brittle bones prone to fractures, especially fragility fractures.
  
  

Inflammation:

Toxins in cigarettes promote inflammation throughout the body, including the spine. This increased inflammation can cause:

• Increased pain and discomfort
• Further degeneration of the spine

The Effects of Smoking on Spine Surgery

Surgery is sometimes recommended for people with spine damage. However, outcomes are generally worse among current smokers.

“Several studies come to the same conclusion, that smoking is detrimental,” Dr. Shah says. “It can lead to delayed healing and increased risk of infection and complications.”

Smoking impacts blood flow, which can affect surgical healing, including: 

• Delayed wound healing: Reduced blood flow slows the delivery of nutrients and oxygen needed for tissue repair.
• Higher infection risk: Impaired circulation weakens the immune response at the surgical site, increasing susceptibility to infection.
• Compromised bone healing: Inadequate blood supply hinders bone regeneration and fracture healing.
• Increased post-surgical complications: Poor blood flow elevates the risk of complications like:
• Wound infections
• Blood clots 
• Pneumonia
• Increased pain
  
  

Why Smokers Should Quit Before Getting Spine Surgery

Quitting may improve your chances of successful recovery after back surgery. In some cases, surgery isn’t even an option for current smokers.

“There are now insurance companies that require you to stop smoking, or fusion surgery is not allowed,” Dr. Shah says. “There are significant issues if bones don’t heal properly after surgery, that lead to poor long-term outcomes and postoperative complications.”

Patients should quit smoking for three months before undergoing spine surgery, according to Dr. Shah.

“Quitting is a very hard thing to do, and it takes the average person several attempts to quit, so I understand that,” Dr. Shah says. “Ideally, I say three months before surgery, but I try to wait for as long as they can stay off of cigarettes.”

Non-smokers are less likely to develop infections after spine surgery compared to smokers. They’re also more likely to experience less pain during recovery.

“There’s a correlation between smoking and post-operative pain management,” Dr. Shah says. “Non-smokers typically report that they have better pain control after surgery.”

Making an effort to quit smoking can benefit your spine health, whether or not you need surgery in the future.

“The improvement in bone health is important because the stronger the bones are, the more it enhances your overall success, even if they are not a candidate for surgery,” Dr. Shah says. 

Next Steps & Resources:

• Meet our source: Shalin Shah, D.O.
• To make an appointment with Dr. Shah or a doctor near you, call 800-822-8905 or visit our website. 
• Learn more about spine and orthopedic care at Hackensack Meridian Health.