When to Quit Smoking

Based upon the previous discussion, the best approach for smokers facing spinal fusion is to stop smoking and remain non-smokers. This results in the best outcomes including a solid fusion and other desired outcomes, such as pain reduction.

However, research consistently demonstrates that this is easier said than done. The Glassman et al. (2000) study nicely exemplifies this problem. All patients in the study were recommended to stop smoking before the surgery and to continue to stay abstinent post-operatively.

Of the 188 patients who smoked, 125 were able to quit smoking for at least some length of time and 63 did not quit at all.

Results of Stop Smoking Study

Typically, patients who do not quit prior to spinal fusion surgery make a commitment to stop immediately after the surgery, although this was not specified in the article. Of the 125 patients who quit, 74 stopped for less than 1-month prior to surgery and 51 stopped for greater than 1-month prior to surgery.

The following Table (I) represents how each group of smokers did with their smoking cessation post-operatively based upon the length they are able to quit prior to surgery:

Table I. Quitting smoking before surgery and how it relates to continued smoking cessation after surgery.

Smoking Status Before Surgery Not Smoking at 1-month Post-Operative Not Smoking at 6-months Post-Operative
Did not quit 10% 6%
Quit for less than 1 month 88% 50%
Quit for more than 1 month 96% 63%
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Difficultly of Quitting Smoking After Back Surgery

As can be seen, if the patient has not successfully quit smoking before spinal fusion surgery, it is highly unlikely that the patient will quit smoking after the surgery.

Most physicians involved in spine surgery find that patients will say with great conviction that they will smoke until the spine surgery and then quit afterwards.

In the overwhelming majority of cases, however, the patient is not able to quit smoking post-operatively, or only does so for a brief period of time.

The recovery from a spine fusion surgery is stressful physically, mentally and emotionally.

Patients often find that the first two months of recovering are especially tough due to acute pain from surgery healing, functional restrictions, and just "boredom." It is exactly these factors that induce a smoker to use cigarettes to "pass the time," "enjoy a rewarding experience," "deal with the stress," etc.

Another important finding in the study is the longer a person has been abstinent from smoking prior to the surgery, the greater likelihood he or she will be able to maintain being a non-smoker post-operatively. This information provides useful guidelines for patients and surgeons relative to preparing for spine surgery, including smoking cessation.

The Amount a Person Smokes Affects Their Ability To Quit Post-Surgery

The Glassman study was also able to investigate how the amount a person smokes affects ability to not smoke after spinal fusion.

Of the 125 patients who were able to stop smoking for any length of time before surgery, the amount the person smoked prior to surgery predicted their ability to stay abstinent. This can be seen in the Table II.

Table II. Amount of cigarette use pre-operatively and rates of abstinence post-operatively.

Smoking Amount Before Surgery Not Smoking at 1-month Post-Operative Not Smoking at 6-months Post-Operative
Less than 1 pack per day 78% 57%
1 to 2 packs per day 63% 39%
More than 2 packs per day 42% 19%

The results are consistent with common sense: the more you smoke the harder it is to quit smoking and stay abstinent, and with the additional stresses following surgery it is likely even more difficult to quit smoking after surgery than it is before.

This statement is still true even if patients know that returning to smoking threatens the outcome of their surgery. The data also show that it is difficult to quit smoking over the long term (6 months or greater) for all levels of cigarette use.