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Gomez-Rice A, Capdevila-Bayo M, Núñez-Pereira S, Haddad S, Pérez-Grueso F, Kleinstück F, Obeid I, Alanay A, Pellise F, Pizones J. Influence of smoking on patient-reported outcome measures (PROMs) in patients undergoing surgery for adult spinal deformity: a propensity score-matched analysis. Spine Deform 2024; 12:819-827. [PMID: 38329602 DOI: 10.1007/s43390-024-00821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/31/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE The purpose of this study was to determine the isolated influence of smoking in patient-reported outcome measures (PROMs) for adult spinal deformity (ASD) surgery excluding known tobacco-related complications. METHODS Retrospective analysis of a prospective multicenter ASD database. Patients operated on ASD with 2 year post-operative follow-up were included. Former smokers (non-active smokers) and patients developing mechanical or infectious complications were excluded. Changes of PROMs over time were analyzed using mixed models for repeated measures (MMRM). Propensity score matching (PSM) (1:1 ratio, caliper 0.10) was performed without replacement using optimum algorithm, tolerance ≤ 0.001, and estimated with 95% confidence interval (CI). PROMS in both groups were compared by paired t test or Wilcoxon signed-rank test. RESULTS 692 out of 1246 surgical patients met our inclusion criteria. 153 smokers were matched with 153 non-smokers according to age, BMI, number of fused levels, and global tilt. After PSM both groups were homogeneous regarding baseline parameters, surgical data, and complications (mechanical complications and infection excluded). Smokers had worse baseline results for SRS-total, SRS-pain COMI-back, and ODI; smokers also showed worse 2-year outcomes for SRS-total, SRS-function, SRS-pain, SRS-self-image, and ODI. However, no differences between the two groups were found in the improvement from baseline to 2-year follow-up or in the timing of this improvement (MMRM). The proportion of patients reaching the minimal clinically important difference (MCID) after surgery was similar in the two groups, but the proportion of patients reaching patient acceptable symptom state (PASS) was significantly lower in smokers for SRS-Subtotal, SRS-function, and SRS-image. CONCLUSION Even in the absence of smoking-related complications, smokers had worse PROMs at baseline and 2 years after surgery with less patients achieving PASS, but similar degrees on improvement compared to non-smokers. The proportion achieving MCID was also similar between the two cohorts.
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Affiliation(s)
- Alejandro Gomez-Rice
- Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9, 100, 28034, Madrid, Spain.
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Kawakami M, Takeshita K, Inoue G, Sekiguchi M, Fujiwara Y, Hoshino M, Kaito T, Kawaguchi Y, Minetama M, Orita S, Takahata M, Tsuchiya K, Tsuji T, Yamada H, Watanabe K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication. J Orthop Sci 2023; 28:46-91. [PMID: 35597732 DOI: 10.1016/j.jos.2022.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine. METHODS The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members. RESULTS Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided. CONCLUSIONS The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.
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Affiliation(s)
| | | | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | - Yasushi Fujiwara
- Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Japan
| | | | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Japan
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Raines BT, Stannard JT, Stricklin OE, Stoker AM, Choma TJ, Cook JL. Effects of Caffeine on Intervertebral Disc Cell Viability in a Whole Organ Culture Model. Global Spine J 2022; 12:61-69. [PMID: 32935580 PMCID: PMC8965308 DOI: 10.1177/2192568220948031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVE To investigate the impact of exposure to physiologically relevant caffeine concentrations on intervertebral disc (IVD) cell viability and extracellular matrix composition (ECM) in a whole organ culture model as potential contributing mechanisms in development and progression of IVD disorders in humans. Primary outcome measures were IVD viable cell density (VCD) and ECM composition. METHODS A total of 190 IVD whole organ explants from tails of 16 skeletally mature rats-consisting of cranial body half, endplate, IVD, endplate, and caudal body half-were harvested. IVD explants were randomly assigned to 1 of 2 groups: uninjured (n = 90) or injured (20G needle disc puncture/aspiration method, n = 100). Explants from each group were randomly assigned to 1 of 3 treatment groups: low caffeine (LCAF: 5 mg/L), moderate caffeine (MCAF: 10 mg/L), and high caffeine (HCAF: 15 mg/L) concentrations. RESULTS Cell viability was significantly higher in the low-caffeine group compared with the high-caffeine group at day 7 (P = .037) and in the low-caffeine group compared with the medium- and high-caffeine groups at day 21 (P ≤ .004). Analysis of ECM showed that all uninjured and control groups had significantly higher (P < .05) glycosaminoglycan concentrations compared with all injured groups. Furthermore, we observed a temporal, downward trend in proteoglycan to collagen ratio for the caffeine groups. CONCLUSIONS Caffeine intake may be a risk factor for IVD degeneration, especially in conjunction with disc injury. Mechanisms for caffeine associated disc degeneration may involve cell and ECM, and further studies should elucidate mechanistic pathways and potential benefits for caffeine restriction.
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Affiliation(s)
- Benjamin T. Raines
- University of Missouri, Columbia, MO, USA,University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | - James L. Cook
- University of Missouri, Columbia, MO, USA,James L Cook, Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO 65212, USA.
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Rajesh N, Moudgil-Joshi J, Kaliaperumal C. Smoking and degenerative spinal disease: A systematic review. BRAIN AND SPINE 2022; 2:100916. [PMID: 36248118 PMCID: PMC9560562 DOI: 10.1016/j.bas.2022.100916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/28/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
Smoking is a major cause of morbidity and mortality worldwide and is responsible for the death of more than 8 million people per year globally. Through a systematic literature review, we aim to review the harmful effects of tobacco smoking on degenerative spinal diseases (DSD). DSD is a debilitating disease and there is a need to identify if smoking can be an attributable contender for the occurrence of this disease, as it can open up avenues for therapeutic options. Sources such as PubMed and Embase were used to review literature, maintaining tobacco smoking and spinal diseases as inclusion factors, excluding any article that did not explore this relationship. Risk of bias was assessed using analysis of results, sample size and methods and limitations. Upon review of the literature, tobacco smoking was found to be a major risk factor for the occurrence of DSDs, particularly lumbar spinal diseases. Smokers also experienced a greater need for surgery and greater postoperative wound healing complications, increased pain perception, delay in recovery and decreased satisfaction after receiving surgery. These effects were noted along the entire spine. Many mechanisms of action have been identified in the literature that provide plausible pictures of how smoking leads to spinal degeneration, exploring possible primary targets which can open up opportunities to develop potential therapeutic agents. More studies on cervical and thoracic spinal degeneration would be beneficial in identifying the effect of nicotine on these spinal levels. Some limitations included insufficient sample size, inconclusive evidence and lack of sufficient repeat studies. However, there appears to be a sufficient amount of research on smoking directly contributing to lumbar spinal pathology. Smoking is a risk factor for the occurence of degenerative spinal disease (DSD). There are numerous pathological mechanisms attributed to spinal pathology by smoking. Smoking appears to be a significant risk factor for lumbar DSDs, with smoke studies also suggesting its role in cervical DSDs. There is insufficient research on the effect of smoking on the thoracic spine. Smoking leads to worse outcomes and potential complications post-surgery, as well as increased pain perception and poorer subjective response post-surgery.
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Divi SN, Woods BI, Goyal DKC, Galetta MS, Nicholson KJ, Dimatteo AL, Lam ME, Qureshi MA, Anderson DG, Kurd MF, Rihn JA, Kaye ID, Kepler CK, Hilibrand AS, Vaccaro AR, Radcliff KE, Schroeder GD. Do Patients with Back Pain-Dominant Symptoms Improve After Lumbar Surgery for Radiculopathy or Claudication? Int J Spine Surg 2021; 15:780-787. [PMID: 34266928 DOI: 10.14444/8100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Currently, few studies have examined whether patients with back or leg pain-predominant symptoms fare better clinically after lumbar spine surgery; therefore, the purpose of this study was to determine whether patients with back pain-dominant symptoms improved to a similar degree as patients with mixed or leg pain-dominant symptoms after lumbar surgery. METHODS A retrospective cohort study was conducted at a single academic center, in which patients were stratified into three groups: (1) back pain-dominant group (B) (visual analog score [VAS] back - VAS leg ≥ 1.0 point), (2) neutral group (N) (VAS back - VAS leg < 1.0 point), or (3) leg pain-dominant group (L) (VAS leg - VAS back ≥ 1.0 point), using a VAS threshold difference of 1.0 point. As a secondary analysis, the VAS leg-to-back pain (LBR) ratio was used to further stratify patients: (1) nonleg pain-dominant (NLPD) group (LBR ≤ 1.0) or (2) leg pain-dominant (LPD) group (LBR > 1.0). Patient outcomes, including physical component score of the short form-12 survey (PCS-12), mental component score of the short form-12 survey (MCS-12), and Oswestry Disability Index (ODI), were identified and compared between groups using univariate and multivariate analysis. RESULTS There were no significant differences in preoperative, postoperative, or delta scores for PCS-12 or ODI scores between groups. In patients undergoing decompression surgery, those with back pain-dominant or mixed symptoms (B, N, or NLPD groups) did not improve with respect to MCS-12 scores after surgery (P > .05), and those with leg pain-dominant symptoms (LPD group) had greater delta MCS-12 scores (P = .046) and greater recovery rates (P = .035). Multiple linear regression did not find LPD to be an independent predictor of PCS-12 or ODI scores. CONCLUSION Patients undergoing lumbar decompression surgery and leg pain-dominant symptoms noted a greater improvement in MCS-12 scores; however, there were no differences in PCS-12 or ODI scores. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Patients undergoing lumbar decompression surgery demonstrate no major clinically significant differences when split up by pain-dominance groups.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Galetta
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristen J Nicholson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew L Dimatteo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Meghan E Lam
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahir A Qureshi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - D Greg Anderson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristen E Radcliff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Goyal DKC, Divi SN, Bowles DR, Mujica VE, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Does Smoking Affect Short-Term Patient-Reported Outcomes After Lumbar Decompression? Global Spine J 2021; 11:727-732. [PMID: 32875911 PMCID: PMC8165909 DOI: 10.1177/2192568220925791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The goal of this study was to determine how smoking status influences patient-reported outcome measurements (PROMs) in patients undergoing lumbar decompression surgery. METHODS Patients undergoing lumbar decompression between 1 to 3 levels at a single-center, academic hospital were retrospectively identified. Patients <18 years old, and those undergoing surgery for infection, trauma, tumor, or revision, with less than 12 months of follow-up were excluded. Patients were divided into 3 groups: (1) never smokers (NSs); (2) current smokers (CSs); and (3) former smokers (FSs). PROMs analyzed included the Physical Component Score and Mental Component Score of the Short Form-12 Health Survey, the Oswestry Disability Index, and Visual Analogue Scale Back and Leg pain scores. One-way ANOVA was used to compare preoperative and postoperative scores between smoking groups, and multiple linear regression analysis was performed to determine whether smoking status predicted change in each outcome score, controlling for factors such as age, sex, body mass index, and other clinical variables. A P value <.05 was considered to be significant. RESULTS A total of 195 patients were included in the final cohort, with 121 (62.1%) patients in the NS group, 22 (11.3%) in the CS group, and 52 (26.6%) in the FS group. There were no significant differences between groups at baseline or postoperatively. Smoking status was also not a significant predictor of change in any outcome scores over time on multivariate analysis. CONCLUSION These results suggest that smoking status does not significantly affect short-term complications or outcomes in patients undergoing lumbar decompression surgery.
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Affiliation(s)
- Dhruv K. C. Goyal
- Thomas Jefferson University, Philadelphia, PA, USA,Dhruv K. C. Goyal, Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | | | | | | | | | - Mark F. Kurd
- Thomas Jefferson University, Philadelphia, PA, USA
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Kuo YH, Kuo CH, Chang HK, Tu TH, Fay LY, Chang CC, Cheng H, Wu CL, Lirng JF, Wu JC, Huang WC. Effects of smoking on pedicle screw-based dynamic stabilization: radiological and clinical evaluations of screw loosening in 306 patients. J Neurosurg Spine 2020; 33:398-405. [PMID: 32357328 DOI: 10.3171/2020.2.spine191380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion. However, there is a paucity of data on the effects of smoking in dynamic stabilization following lumbar spine surgery. This study aimed to investigate the clinical outcomes and the incidence of screw loosening among patients who smoked. METHODS Consecutive patients who had lumbar spondylosis, recurrent disc herniations, or low-grade spondylolisthesis that was treated with 1- or 2-level surgical decompression and pedicle screw-based Dynesys dynamic stabilization (DDS) were retrospectively reviewed. Patients who did not complete the minimum 2 years of radiological and clinical evaluations were excluded. All screw loosening was determined by both radiographs and CT scans. Patient-reported outcomes, including visual analog scale (VAS) scores of back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI), were analyzed. Patients were grouped by smoking versus nonsmoking, and loosening versus intact screws, respectively. All radiological and clinical outcomes were compared between the groups. RESULTS A total of 306 patients (140 women), with a mean age of 60.2 ± 12.5 years, were analyzed during an average follow-up of 44 months. There were 34 smokers (9 women) and 272 nonsmokers (131 women, 48.2% more than the 26.5% of smokers, p = 0.017). Postoperatively, all the clinical outcomes improved (e.g., VAS back and leg pain, JOA scores, and ODI, all p < 0.001). The overall rate of screw loosening was 23.2% (71 patients), and patients who had loosened screws were older (61.7 ± 9.6 years vs 59.8 ± 13.2 years, p = 0.003) and had higher rates of diabetes mellitus (33.8% vs 21.7%, p = 0.038) than those who had intact DDS screws. Although the patients who smoked had similar clinical improvement (even better VAS scores in their legs, p = 0.038) and a nonsignificantly lower rate of screw loosening (17.7% and 23.9%, p = 0.416), the chances of secondary surgery for adjacent segment disease (ASD) were higher than for the nonsmokers (11.8% vs 1.5%, p < 0.001). CONCLUSIONS Smoking had no adverse effects on the improvements of clinical outcomes in the pedicle screw-based DDS surgery. For smokers, the rate of screw loosening trended lower (without significance), but the chances of secondary surgery for ASD were higher than for the nonsmoking patients. However, the optimal surgical strategy to stabilize the lumbar spine of smoking patients requires future investigation.
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Affiliation(s)
- Yi-Hsuan Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Chao-Hung Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 3Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University
| | - Hsuan-Kan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 4Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University
| | - Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 6Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica; and
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 5Institute of Pharmacology, National Yang-Ming University
| | - Chih-Chang Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 5Institute of Pharmacology, National Yang-Ming University
| | - Ching-Lan Wu
- 2School of Medicine, National Yang-Ming University
- 7Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- 2School of Medicine, National Yang-Ming University
- 7Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
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Kiraz M, Demir E. Relationship of lumbar disc degeneration with hemoglobin value and smoking. Neurochirurgie 2020; 66:373-377. [PMID: 32866500 DOI: 10.1016/j.neuchi.2020.06.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/06/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE Although a number of studies report an important effect of smoking on disc degeneration and herniation, others did not identify such a relationship. The purpose of this study was to assess the relationship of lumbar disc degeneration with hemoglobin value and smoking. METHODS The study included 200 adult patients who presented to the neurosurgery polyclinic with a complaint of back pain. Smoking habits were classified as "smoking for more than 10 years", "smoking for less than 10 years", and "not smoking". Lumbar disc degeneration was classified on modified Pfirrmann score according to lumbar MR images. Degeneration level was compared according to smoking group on Kruskal-Wallis test. The relationship between hemoglobin value and disc degeneration according to smoking group was assessed on the Spearman correlation coefficient. RESULTS Disc degeneration values were significantly different between groups in L5-S1, L4-L5 and L3-L4 (P=0.018, P=0.012, P=0.038). Degeneration levels in L5-S1 in those who did not smoke were significantly lower than in those who smoked for both less and more than 10 years (P=0.048, P=0.022). No significant differences were found in degeneration level between those who smoked for more versus less than 10 years. For L3-L4 degeneration, there was a significant relationship with hemoglobin value in the group that did not smoke and in the group that smoked for more than 10 years (r=-0.395; P=0.009, r=0.329; P=0.018). CONCLUSION This study found that, when risk factors such as systemic disease, heavy working conditions, obesity, trauma and family history were excluded, smoking increased lumbar disc degeneration. In addition, chronic smoking was found to increase hemoglobin values.
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Affiliation(s)
- M Kiraz
- Department of Neurosurgery, Faculty of Medicine, Hitit University, Çorum, Turkey.
| | - E Demir
- Department of Biostatistics, Faculty of Medicine, Hitit University, Çorum, Turkey
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Padevit L, Sarnthein J, Stienen MN, Krayenbühl N, Bozinov O, Regli L, Neidert MC. Smoking status and perioperative adverse events in patients undergoing cranial tumor surgery. J Neurooncol 2019; 144:97-105. [DOI: 10.1007/s11060-019-03206-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
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Abstract
STUDY DESIGN Retrospective longitudinal cohort. OBJECTIVES To determine if former smokers undergoing lumbar spine surgery have distinct baseline and postoperative patient-reported outcomes (PROs) compared with never smokers and current smokers. SUMMARY OF BACKGROUND DATA Smoking has known deleterious effects on patients undergoing lumbar spine surgery. However, former smokers have not been extensively evaluated. There are few studies regarding the relationship between pack-years or duration of smoking cessation, and subsequent clinical outcome. METHODS Patients undergoing lumbar spine surgery at three Quality Outcomes Database participating sites were identified. Demographic, surgical and PRO data including pre-op and 12-month post-op back and leg pain scores, Oswestry Disability Index (ODI) and EuroQOL-5D were collected. Smoking status was assessed from individual medical records. Three cohorts, never smokers, former smokers and current smokers, were compared. Association between PROs and quantitative smoking history and duration of pre-op smoking cessation were evaluated in the former smokers. RESULTS Of 1187 eligible cases, 843 (71%) had complete data, with 477 never, 250 former, and 116 current smokers. Among patients who had a fusion, baseline and 12-month post-op PROs were significantly different between cohorts, with former smokers having intermediate scores between current and never smokers. In the decompression only group, 12-month ODI was worse in the Current smokers, but overall the effects were much less pronounced. There was a significant negative correlation between smoke-free days before surgery and baseline back pain, ODI, 12-month leg pain and ODI and improvement in ODI. However, the correlation coefficients were small. CONCLUSION Former smokers have distinct baseline and 12-month post-op PROs that are intermediate between those of never smokers and current smokers. Smoking cessation does not entirely mitigate the negative effects of smoking on baseline and postoperative PROs for patients undergoing lumbar fusion surgery. This effect is less pronounced in patients undergoing decompression alone. LEVEL OF EVIDENCE 2.
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Abstract
BACKGROUND Spinal fusion surgery is performed about half a million times per year in the United States and millions more worldwide. It is an effective method for reducing pain, increasing stability, and correcting deformity in patients with various spinal conditions. In addition to being a well-established risk factor for a variety of medical conditions, smoking has deleterious effects on the bone healing of spinal fusions. This review aims to specifically analyze the ways in which smoking affects the outcomes of spinal fusion and to explore ways in which these negative consequences can be avoided. PURPOSE This article provides a complete understanding of the ways smoking affects spinal fusion from a biochemical and clinical perspective. Recommendations are also provided for ways in which surgeons can limit patient exposure to the most serious negative outcomes associated with cigarette smoking. STUDY DESIGN/SETTING This study was a retrospective literature review done using the NCBI database. The research was compiled at NYU Hospital for Joint Diseases and the NYU Center for Musculoskeletal Care. METHODS A comprehensive literature review was done spanning research on a variety of subjects related to smoking and spinal fusion surgery. The biochemistry of smoking and fusion healing were examined in great detail. In addition, both in vivo animal studies and human clinical studies were evaluated to explore fusion success related to the effects of smoking and its biochemical factors on spinal fusion surgery. RESULTS Smoking significantly increases the risk of pseudoarthrosis for patients undergoing both lumbar and cervical fusions. In addition to nonunion, smoking also increases the risk of other perioperative complications such as infection, adjacent-segment pathology, and dysphagia. Treatment options are available that can be explored to reduce the risk of smoking-related morbidity, such as nicotine replacement therapy and use of bone morphogenetic proteins (BMPs). CONCLUSIONS It has been clearly demonstrated from both a biochemical and clinical perspective that smoking increases the rate of perioperative complications for patients undergoing spinal fusion surgery, particularly pseudoarthosis. It has also been shown that there are certain approaches that can reduce the risk of morbidity. The most important recommendation is smoking cessation for four weeks after surgery. In addition, patients may be treated with certain surgical techniques, including the use of BMPs, to reduce the risk of pseudoarthrosis. Lastly, nicotine replacement therapy is an area of continued interest in relation to spinal fusion outcomes and more research needs to be done to determine its efficacy moving forward.
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Affiliation(s)
| | | | - John Bendo
- NYU Hospital for Joint Diseases, Manhattan, NY
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Nie HY, Qi YB, Li N, Wang SL, Cao YX. Comprehensive comparison of therapeutic efficacy of radiofrequency target disc decompression and nucleoplasty for lumbar disc herniation: a five year follow-up. INTERNATIONAL ORTHOPAEDICS 2017; 42:843-849. [PMID: 29090325 DOI: 10.1007/s00264-017-3661-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/24/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the therapeutic efficacy of radiofrequency target disc decompression(TDD) and nucleoplasty for lumbar disc herniation. METHODS Two hundred sixty patients with lumbar disc herniation were divided into two groups: target disc decompression group (group T, n = 147) and nucleoplasty group (group N, n = 113). Visual analogue scale (VAS) and functional rating index (FRI) were measured at one, three, six, 12, 24, and 60 months after the surgery. Hospitalization time, operation time, complications, and recurrence/invalid were compared between the two groups. RESULTS Compared with the pre-operation, the VAS and FRI in both groups were significantly decreased in post-operation(P < 0.01). The VAS and FRI in group T have no significant difference compared to those in group N. The hospitalization and operation time of group T were significantly longer than those in group N. There was no significant difference of the occurrence of complications and disease recurrence/invalid during the follow-up between the two groups. Logstic regression analysis showed that operation time was an independent factor in the prognosis. Operation time affects the treatment effect. Shorter operation time leads to better therapeutic efficacy, and longer operation time leads to poor therapeutic efficacy. CONCLUSIONS Both TDD and nucleoplasty can reduce pain in patients with lumbar disc herniation and improve quality of life. Group N had shorter hospitalization and operation time than group T.
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Affiliation(s)
- Hui-Yong Nie
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.,Department of Pharmacology, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, 710061, China
| | - Ya-Bin Qi
- The Second Department of General Surgery, Xi'an Ninth Hospital Affiliated to Medcal College of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Na Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Suo-Liang Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Yong-Xiao Cao
- Department of Pharmacology, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, 710061, China.
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Madsbu MA, Salvesen Ø, Werner DAT, Franssen E, Weber C, Nygaard ØP, Solberg TK, Gulati S. Surgery for Herniated Lumbar Disc in Daily Tobacco Smokers: A Multicenter Observational Study. World Neurosurg 2017; 109:e581-e587. [PMID: 29045852 DOI: 10.1016/j.wneu.2017.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare clinical outcomes at 1 year following single-level lumbar microdiscectomy in daily tobacco smokers and nonsmokers. METHODS Data were collected through the Norwegian Registry for Spine Surgery. The primary endpoint was a change in the Oswestry Disability Index (ODI) at 1 year. Secondary endpoints were change in quality of life measured with EuroQol 5 Dimensions (EQ-5D), leg and back pain measured with a numerical rating scale (NRS), and rates of surgical complications. RESULTS A total of 5514 patients were enrolled, including 3907 nonsmokers and 1607 smokers. A significant improvement in ODI was observed for the entire cohort (mean, 31.1 points; 95% confidence interval [CI], 30.4-31.8; P < 0.001). Nonsmokers experienced a greater improvement in ODI at 1 year compared with smokers (mean, 4.1 points; 95% CI, 2.5-5.7; P < 0.001). Nonsmokers were more likely to achieve a minimal important change (MIC), defined as an ODI improvement of ≥10 points, compared with smokers (85.5% vs. 79.5%; P < 0.001). Nonsmokers experienced greater improvements in EQ-5D (mean difference, 0.068; 95% CI, 0.04-0.09; P < 0.001), back pain NRS (mean difference, 0.44; 95% CI, 0.21-0.66; P < 0.001), and leg pain NRS (mean difference, 0.54; 95% CI, 0.31-0.77; P < 0.001). There was no difference between smokers and nonsmokers in the overall complication rate (6.2% vs. 6.7%; P = 0.512). Smoking was identified as a negative predictor for ODI change in a multiple regression analysis (P < 0.001). CONCLUSIONS Nonsmokers reported a greater improvement in ODI at 1 year following microdiscectomy, and smokers were less likely to experience an MIC. Nonetheless, significant improvement was also found among smokers.
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Affiliation(s)
- Mattis A Madsbu
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - David A T Werner
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway; Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Eric Franssen
- Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway; Norwegian National Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Tore K Solberg
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway; Department of Clinical Medicine, University of Tromsø, Tromsø, Norway; Norwegian National Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway
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Connolly J, Javed Z, Raji MA, Chan W, Kuo YF, Baillargeon J. Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery. Spine (Phila Pa 1976) 2017; 42:1405-1411. [PMID: 28263225 PMCID: PMC5582019 DOI: 10.1097/brs.0000000000002133] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A population-based retrospective cohort study. OBJECTIVE The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults. SUMMARY OF BACKGROUND DATA Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention. METHODS Using one of the nation's largest commercial insurance databases, we conducted a retrospective cohort study of 8377 adults, aged 21 to 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009, and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long-term opioid use following lumbar fusion. RESULTS After adjusting for covariates, the following factors were associated with an increased risk of long-term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1-22 days) OR = 2.27, 95% CI = 1.48-3.49; Quartile 2 (23-72 days): OR = 5.94, 95% CI = 4.00-8.83; Quartile 3: (73-250 days) OR = 25.31, 95% CI = 17.26-37.10; Quartile 4 (≥250 days) OR = 219.95, 95% CI = 148.53-325.71)], refusion surgery (OR = 1.32, 95% CI = 1.02-1.72), and diagnosis of depression (OR = 1.43, 95% CI = 1.18-1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR = 0.79, 95% CI = 0.63-0.99). CONCLUSION These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Joseph Connolly
- U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, OH
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
| | - Zulqarnain Javed
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
| | - Mukaila A. Raji
- U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, OH
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
- Department of Internal Medicine, University of Texas Medical Branch
- Sealy Center on Aging, University of Texas Medical Branch
| | - Winston Chan
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
| | - Yong-Fang Kuo
- U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, OH
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
- Department of Internal Medicine, University of Texas Medical Branch
- Sealy Center on Aging, University of Texas Medical Branch
| | - Jacques Baillargeon
- U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, OH
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
- Sealy Center on Aging, University of Texas Medical Branch
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Joswig H, Stienen MN, Smoll NR, Corniola MV, Chau I, Schaller K, Hildebrandt G, Gautschi OP. Effects of Smoking on Subjective and Objective Measures of Pain Intensity, Functional Impairment, and Health-Related Quality of Life in Lumbar Degenerative Disk Disease. World Neurosurg 2017; 99:6-13. [DOI: 10.1016/j.wneu.2016.11.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/16/2022]
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Short- and Long-Term Outcome of Microscopic Lumbar Spine Surgery in Patients with Predominant Back or Predominant Leg Pain. World Neurosurg 2016; 93:458-465.e1. [DOI: 10.1016/j.wneu.2016.06.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022]
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