An extensive amount of research has firmly established that cigarette smoking is bad for patients undergoing lumbar fusion surgery. But just how bad is smoking? How does it impact a spinal fusion? What do I need to know to help my chances of successfully quitting smoking? This article addresses those questions and more.

Smoking causes a number of significant problems for patients undergoing spinal fusion including the following:

  • A significantly decreased rate of successful fusion (called non-union or pseudoarthroses)
  • Markedly poorer clinical outcomes (i.e. pain reduction) regardless of whether or not a successful fusion in the spine is achieved
  • Poorer functional rehabilitation after surgery
  • Lower overall patient satisfaction with the spine surgery

    Read more: Maximize the Ability to Heal After Spine Fusion Surgery

Given these findings, quitting smoking prior to a spinal fusion (and remaining a non-smoker) can greatly enhance a patient’s chances for achieving pain reduction and a successful clinical outcome.


Importantly, the information presented in this article applies not just to cigarette smoking but to all forms of nicotine and any product that introduces nicotine into one's system, such as:

  • Chewing tobacco
  • Cigars
  • Pipes
  • Nicotine patches
  • Nicotine gum

Benefits of Quitting Smoking Before Spinal Fusion

Philosophically, it is perfectly reasonable for a surgeon to not agree to do a fusion surgery until after a patient has quit smoking. Unlike many surgeries, fusion surgeries are not usually medically necessary - having the surgery is the patient’s choice. And it is an extensive surgery that requires a lot of healing.

See Resources to Help Quit Smoking

It is reasonable to ensure that the patient is in the best healing position possible prior to proceeding with surgery. Accordingly, many spine surgeons will require their patients to have a urine test prior to a spinal fusion to ensure that there is no nicotine in their system and they have indeed quit smoking.


All of the research and clinical findings presented in this article underscore the importance of quitting smoking prior to a spine fusion and avoiding smoking post-operatively. In addition, the research shows that:

  • If you smoke up until the time of surgery you are very unlikely to quit after surgery. It is best to quit at least one month prior to surgery.
  • The more you smoke before surgery, the harder it will be to maintain abstinence post-operatively
  • The longer you are abstinent from smoking before surgery, the more likely you will stay abstinent after surgery

    For further reading: Healthy Habits After Back Surgery

Regardless of technical advances to achieve a solid fusion in smokers, the best overall outcomes, notably pain relief, are achieved in non-smokers and smokers who successfully quit smoking.

Understanding these findings can help you and your surgeon develop a treatment plan that has the highest likelihood of helping you quit smoking and having a successful spine fusion surgery outcome that includes a solid fusion as well as greater pain reduction and satisfaction with the surgery.

Dr. William Deardorff is a clinical health psychologist and specializes in providing psychological services to patients with chronic pain and spinal conditions. He has led a private practice for more than 30 years.

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