Question: Has smoking made it impossible for spinal fusion to take place?
My wife had neck surgery in July 2001 with (2) Sulzer BAK/C implants. She's been battling pain ever since. We received a 2nd opinion last week from a very well-known doctor, and he's confident that fusion is not taking place.
She smoked for about the first 6 months after surgery and she took Advil and Vioxx regularly. The surgeon gave her bags of samples of Vioxx and said that Advil would be OK for her to take. He never told her the effects of nicotine. She stopped smoking 6 months ago, but just quit the Vioxx and Advil this week, after meeting with this new doctor.
The new doctor said that there's a chance that fusion will now take place now that she's quit Vioxx, Advil, and smoking. Is it too late or is he correct? What are our options?
Doctor's response: Smoking can cause spinal fusion problems and delayed union
She may have what is known as a delayed union instead of a nonunion. The difference being that the delayed union may heal with time. Now that she is off the anti-inflammatory medications and nicotine, it very well may heal, although at one year out from surgery the chances are less than they would have been immediately after surgery.
There is no absolute test to see if a union has occurred but a thin cut CT scan with sagittal reconstruction is probably the best way to see if there is a fusion within the cages. Another technique that may help this fuse is to try an external bone stimulator. You can talk to your spine surgeon about this.
- Achieving a Spinal Fusion in Smokers
- Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery
In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.