Publication: ADR in Smokers vs. Nonsmokers

[Justin]

Bertagnoli, Rudolf MD *; Yue, James J. MD *; Kershaw, Trace PhD +; Shah, Rahul V. MD ++; Pfeiffer, Frank MD *; Fenk-Mayer, Andrea MD *; Nanieva, Regina *; Karg, Armin *; Husted, Daniel S. MD ++; Emerson, John W. PhD [S]

From the *Department of Orthopaedic Surgery, Spine Center, St. Elizabeth Klinikum, Straubing, Germany; and +School of Public Health, ++Department of Orthopaedic Surgery and Rehabilitation, and [S]Department of Statistics, Yale University, New Haven, CT.

Lumbar Total Disc Arthroplasty Utilizing the ProDisc Prosthesis in Smokers Versus Nonsmokers: A Prospective Study With 2-Year Minimum Follow-up.[Miscellaneous Article]

Spine. 31(9):992-997, April 20, 2006.

Study Design. Prospective nonrandomized clinical series.

Objectives. To evaluate the efficacy of ProDisc lumbar artificial disc replacement (ADR) in smokers versus nonsmokers.

Summary of Background Data. Smoking is a negative predictor in fusion surgery. To date, a prospective study of the treatment of incapacitating discogenic low back pain using ADR in smokers versus nonsmokers has not been described.

Methods. A prospective analysis was performed on 104 patients with disabling discogenic low back pain treated with single-level lumbar ProDisc total disc arthroplasty. Smokers and nonsmokers were assessed before surgery and after surgery using patient satisfaction, Oswestry, and Visual Analog Scores. Additionally, preoperative and postoperative neurologic, radiographic, and pain medication assessments were performed at similar postoperative intervals.

Results. Oswestry, Visual Analog Scores, and patient satisfaction scores revealed statistical improvement beginning 3 months after surgery and were maintained at minimum 2-year follow-up. Patient satisfaction scores were higher in smokers (94%) than in nonsmokers (87%) at 2-year follow-up (P = 0.07). Radiographic analysis revealed an affected disc height increase from 4 mm to 13 mm (P < 0.05) and an affected disc motion from 3[degrees] to 7[degrees] (P < 0.05). No cases of loosening, dislodgment, mechanical failure, infection, or fusion of the affected segment occurred.

Conclusions. The results of our study indicate that smokers do equally well compared with nonsmokers when ProDisc ADR is used in the treatment of debilitating lumbar spondylosis. Patient outcome and radiographic scores showed significant improvement compared with preoperative levels. Although not evident in our series, additional surveillance for intraoperative and postoperative vascular spasm and occlusion may be warranted in smokers.

(C) 2006 Lippincott Williams & Wilkins, Inc.

[Harrison]

Interesting post. These findings contrast with some of the earlier topics -- like the one FAQ I posted that clearly stated how bad smoking is for your spine...

[tmont]

Interesting; I'd never have thought there'd be specific issues between smoking and the spine. This still doesn't make me want to light up tho

Trace

[annapurna]

I think we're playing with statistics here. The link between smoking and deteriorating spine health was supposedly increased onset and advancement of DDD. I think the paper simply says that if you've smoked and screwed up your disks, you can still have a successful ADR. Seems like it would be far cheaper to not smoke and not need ADR.

[sahuaro]

I agree with Annapurna's distinction. Dr. Yue actually mentioned to me (with a chuckle) that smokers seem to do better with the surgery than non-smokers. But he still told me to stop smoking!

[chasswen]

dr yue told me i had to stop smoking period
and lose 9 lbs to be in the activ-l study.
so far ive lost 4 lbs but not doing well with the smoking thing yet
chuck

[Justin]

dr yue told me i had to stop smoking period and lose 9 lbs to be in the activ-l study.
so far ive lost 4 lbs but not doing well with the smoking thing yet

Congrats on the weight loss Chuck! You will kick the habit--I know you can!

Justin

[chasswen]

thanks justin
i will have to do this or smoking will cost me 30k.meaning having to go overseas for the surgery.
chuck