title: Short- and long-term effects of smoking on pain and health-related quality of life after non-instrumented lumbar spine surgery.
abstract: OBJECTIVE
  A myriad of negative bodily health effects related to tobacco smoking is known while its detrimental effects on the spine in particular are less defined. The goal of the current study is to compare long-term outcome between smokers and non-smokers after non-instrumented lumbar spine surgery.
  
  
  METHODS
  Prospective observational study on n=172 consecutive patients undergoing non-instrumented spine surgery for lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS) with a follow-up (FU) of 4.5 years. Patients were dichotomized according to their smoking status at the time of surgery. Back pain and health-related quality of life (HRQoL) were assessed using the visual analogue scale (VAS) and the Short-Form (SF)-12. Any subsequent lumbar spine surgeries since the index surgery were registered. Logistic regression analysis was used to estimate the effect size of the relationship between smoking and the responder status to surgery in terms of pain and HRQoL-metrics.
  
  
  RESULTS
  Complete FU data was available for n=29 (55%) smokers and n=75 (63%) non-smokers. At discharge, 1 month, 1 year and 4.5 years, smokers were as likely as non-smokers to achieve a favourable response to surgery in terms of VAS back pain and the SF-12 mental and physical component scale metric. A subgroup analysis on active smokers throughout the entire study interval did not find an inferior responder rate than in never-smokers. A trend for additional lumbar spine surgery performed in 17.2% of the smoking and 8.2% of the non-smoking patients during FU was observed (OR 2.39, 95% CI 0.67-8.57, p=0.179).
  
  
  CONCLUSIONS
  Up to 4.5 years following non-instrumented lumbar spine surgery, there was no difference in the pain or HRQoL-responder status of smokers and non-smokers. Smokers may be more likely to undergo re-do surgery in the long term, but more data is needed to confirm this statistical trend.
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland. Electronic address: mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Joswig
authors.affiliation: Department of Neurology, John Hunter Hospital, Newcastle, Australia.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Enrico
authors.initials: E
authors.lastname: Tessitore
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010146:Pain / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D012907:Smoking / Q000009:adverse effects*; D013130:Spinal Stenosis / Q000503:physiopathology / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome
keywords: Degenerative disc disease; Functional impairment; Health-related quality of life; Pain; Response to treatment; Smoking