Achieving a Spinal Fusion in Smokers

As this article discusses in detail, the best approach for achieving a successful outcome (e.g. reduced pain) in a spinal fusion patient who smokes is for that person to quit smoking, permanently.

Unfortunately, not all patients are able or willing to quit smoking and alternative surgical procedures have been developed to help offset the negative influence of smoking.

Surgery Techniques For Smokers

Some of the most common methods to help offset the negative effects of smoking are rigid stabilization approaches.

This might include such things as pedicle screw fixation and anterior-posterior fusion (circumferential fusion).

Other procedures might also be used including interbody grafting techniques and bone stimulators.

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Use of Bone Morphogenic Proteins (BMPs) for Smokers

Even with all of these additional efforts, some of which are much more invasive and take longer to heal from, to achieve a solid fusion in a patient who smokes, the non-union/failed fusion rate for people who smoke is still a significant problem.

One of the newest approaches is the use of bone morphogenic proteins (BMP).

BMPs are a group of growth factors known for their ability to induce formation of bone and cartilage. The BMP is placed at the time of surgery and is designed to enhance bone growth beyond what would normally occur by simply using bone from the patient (autografting) or cadaver bone.

In a recent study by Glassman, Dimar et al. (2007), the use of one type of BMP was investigated for smokers and non-smokers undergoing spinal fusion surgery. Patients underwent a single level posterior fusion with instrumentation and the use of BMP.

  • At two years post-operative 100% of the non-smokers and 95% of the smokers achieved a successful fusion. The authors conclude that the use of BMP "may enhance fusion rate in cigarette smokers undergoing single level instrumented posterolateral lumbar fusion" (page 1697).
  • Even so, the authors were careful to point out that the smoker group, even though achieving a high level of successful fusion, still had poorer outcomes compared to the non-smoker group on measures of overall functional and physical symptoms (i.e. pain relief).

These findings are consistent with the research previously reviewed. Glassman et al. (2007) conclude, "While rhBMP-2 matrix is a valuable tool for lumbar fusion in smokers, smoking abatement is still the optimal management technique for patients undergoing lumbar fusion surgery" (page 1697).

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