title: The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2.
abstract: OBJECTIVE
  The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs.
  
  
  METHODS
  Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused.
  
  
  RESULTS
  Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48-15.24).
  
  
  CONCLUSIONS
  While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.
authors.affiliation: Mayo Clinic Neuro-Informatics Laboratory, Rochester, Minnesota, USA; Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Macki
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Sbaa
authors.initials: S
authors.lastname: Syeda
authors.affiliation: Mayo Clinic Neuro-Informatics Laboratory, Rochester, Minnesota, USA; The George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Kenan R
authors.initials: KR
authors.lastname: Rajjoub
authors.affiliation: Mayo Clinic Neuro-Informatics Laboratory, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kerezoudis
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Witham
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Mayo Clinic Neuro-Informatics Laboratory, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Bydon.mohamad@mayo.edu.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.affiliation: Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gokaslan
mesh_terms: D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology* / Q000601:surgery*; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D016212:Transforming Growth Factor beta / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2
keywords: Adjacent segment disease; Bone morphogenetic protein; Instrumented fusion; Reoperation