title: The effect of cigarette smoking and smoking cessation on spinal fusion.
abstract: METHODS
  The effect of cigarette smoking and smoking cessation on spinal fusion was studied in a retrospective review of 357 patients who had undergone instrumented spinal fusion.
  
  
  OBJECTIVE
  To document the widely assumed but unreported benefit of cigarette smoking cessation on fusion rate and clinical outcome after spinal fusion surgery.
  
  
  BACKGROUND
  Cigarette smoking has been shown to inhibit lumbar spinal fusion and to adversely effect outcome in treatment of lumbar spinal disorders. Prior reports have compared smokers and nonsmokers, as opposed to comparing smokers and quitters.
  
  
  METHODS
  This study retrospectively identified 357 patients who underwent a posterior instrumented fusion at either L4-L5 or L4-S1 between 1992 and 1996. Analysis of the medical record and follow-up telephone surveys were conducted. Clinical outcome and fusion status was analyzed in relation to preoperative and postoperative smoking parameters.
  
  
  RESULTS
  In this study, the nonunion rate was 14.2% for nonsmokers and 26.5% for patients who continued to smoke after surgery (P < 0.05). Patients who quit smoking after surgery for longer than 6 months had a nonunion rate of 17.1%. The nonunion rate was not significantly affected by either the quantity that a patient smoked before surgery or the duration of preoperative smoking abatement. Return-to-work was achieved in 71% of nonsmokers, 53% of nonquitters, and 75% of patients who quit smoking for more than 6 months after surgery.
  
  
  CONCLUSIONS
  These results validate the hypothetical assumption that postoperative smoking cessation helps to reverse the impact of cigarette smoking on outcome after spinal fusion.
authors.affiliation: Departments of Orthopaedic and Neurological Surgery, University of Louisville School of Medicine, and the Kenton D. Leatherman Spine Center, Louisville, Kentucky 40202, USA. SISS001@aol.com
authors.forename: S D
authors.initials: SD
authors.lastname: Glassman
authors.forename: S C
authors.initials: SC
authors.lastname: Anagnost
authors.forename: A
authors.initials: A
authors.lastname: Parker
authors.forename: D
authors.initials: D
authors.lastname: Burke
authors.forename: J R
authors.initials: JR
authors.lastname: Johnson
authors.forename: J R
authors.initials: JR
authors.lastname: Dimar
mesh_terms: D000328:Adult; D000367:Age Factors; D016025:Bone Transplantation / Q000009:adverse effects; D001842:Bone and Bones / Q000187:drug effects*; D003710:Demography; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010012:Osteogenesis / Q000187:drug effects*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000534:rehabilitation; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology