Smoking and Back Surgery – Jeffrey R. Carlson, MD

Orthopaedic & Spine Center

As a Spine Surgeon, the standard instructions I give to patients when preparing for spinal surgery always includes telling them to stop taking their blood thinners (including ibuprofen, naproxen and aspirin), not to eat or drink after midnight the day of their surgery and to stop smoking before and after surgery. Most patients generally understand the reasoning for stopping the blood thinners, i.e., they don’t want to lose more blood during their surgery, and that eating before anesthesia can lead to vomiting and possible pneumonia due to the chance of inhaling stomach contents. However, getting patients to understand the critical reasons for smoking cessation before and after surgery and subsequently, getting a patient to then stop smoking, presents a much greater obstacle for the Spine Surgeon to overcome.

It is commonly known that smoking has deleterious effects on the lungs. Lungs that do not function properly, for any reason, put the surgical patient at a higher risk for complications from anesthesia. Anesthesia puts the body to “sleep” so that the pain from surgery will not be felt. As a result, the brain is often affected and basic autonomic body functions, such as breathing, are depressed and must be monitored during surgery. For any patient that is to undergo anesthesia for surgery, their lungs need to be at peak performance. Those patients who smoke should consider stopping smoking for 3 months prior to their surgery to give the lungs a chance to clear out any of the residual substances deposited from smoking.

It is well-documented that smoking increases back pain. There are multiple studies that have shown smoking to increase the number of back pain events, as well as the severity of those events. Those patients that are undergoing back (spine) surgery obviously have a back problem. Smoking will increase the back pain associated with the diagnosis predicating the surgery, as well as increase the pain related to and after the surgical procedure.

The crucial reason we ask patients to stop smoking after surgery is to allow the surgery the best chance of success. We know that smoking causes our blood to carry less oxygen. The oxygen is what our body needs to survive and most importantly, heal after surgery. In the smoking population, there is a higher risk of the surgical procedure not healing. There are some very good studies which look at the rate of healing after spinal fusion surgery. One, in particular, from the journal SPINE (2000), follows 357 patients that needed to have lumbar (lower spine) spinal fusion surgery. In this study, the patients were the same, except that some chose to continue smoking after surgery. As a result, they found that 26.5% of the patients that continued to smoke after surgery did not heal their fusion, which is called a non-union. A non-union not only leads to an increase in back pain, but also a failure of the surgery to improve the patient’s life by decreasing their pain. The study also found that only 53% of patients that continued to smoke after surgery returned to their normal work, compared to a return-to- normal work rate of 75% for patients that quit smoking for 6 months after surgery. This clearly shows the harmful effects of smoking on spinal fusion surgery and the effects on the patient’s work and lifestyle.

Prior to surgery, you must seriously consider the effects that smoking will have on the outcome of your surgery. You should understand the real possibility of facing a follow-up surgery because your initial fusion surgery did not heal. Discussing these issues with a fellowship-trained spine surgeon will help put your mind at ease for your upcoming surgery. There are many tools available to help you quit smoking. Partnering with your specialist to achieve a great outcome puts you in control of your recovery.

Dr. Jeffrey R. Carlson is a fellowship-trained, Board-certified Orthopaedic Spine Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. Dr. Carlson is Chief-of-Surgery at Bon Secours Mary Immaculate Hospital in Newport News, VA. For more information about Dr. Carlson or OSC, go to or call 757-596-1900.