Orthopaedic Institute of Western Kentucky: Nicotine & Spine Surgery - What You Need to Know

by K. Brandon Strenge, MD The Orthopaedic Institute of Western Kentucky

As an orthopaedic surgeon who specializes in spinal surgery practicing in western Kentucky, I frequently see patients in the office who have been smoking for a very long time - often since they were very young. Most people know that smoking can complicate surgery by slowing the healing process, but very few truly understand the science behind why smoking, or more accurately all nicotine products, is so damaging to surgical outcomes.

The reality is any form of nicotine will compromise surgical results. This includes not only cigarettes and oral tobacco, but also nicotine patches, gum, or lozenges and the increasingly popular E-cigarettes or vapor that contain nicotine.

Most orthopaedic procedures involve the healing of soft tissues or bones solidly together as part of the success of the procedure. This process involves new blood vessels called capillaries growing into the surgical area which bring blood and the nutrients it contains to allow proper healing. This is called angiogenesis. The chemical nicotine inhibits this process of new blood vessel growth. Any form of nicotine has this damaging effect and it is dose-dependent, which means the more nicotine that’s consumed, the more difficult it is for the body to heal.

Nicotine has a particularly damaging effect on spinal fusion surgery. This is because it requires spinal bones to grow, or fuse, together to eliminate painful motion and nerve-related pain from stenosis. If the bones fail to heal correctly, additional surgery may be required to remove broken or loose instrumentation (screws and rods) and attempt to redo the fusion. These situations rarely achieve the same level of successful results as the original procedure.

I emphasize to my patients the importance of not using nicotine products if they are having spinal surgery to ensure they get maximum benefit and minimize the risk of complications. It can take six weeks or longer for the damaging effects of nicotine to be eliminated after discontinuing its use. If you or a loved one are scheduled to undergo an orthopaedic procedure, especially a spinal procedure, it’s very important to stop using nicotine products to ensure the best possible outcome. 

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