Oral Posters: Adult Spinal Deformity

Presented by: Y. Park - View Audio/Video Presentation (Members Only)


Y. Park(1), H.Y. Pak(2)

(1) Yonsei University College of Medicine / National Health Insurance Service Ilsan Hospital, Department of Orthopedic Surgery, Goyang, Korea, Republic of
(2) National Health Insurance Service Ilsan Hospital, Goyang, Korea, Republic of


Background: Smoking is associated with diverse health risks, but the precise relationship between smoking and low back pain (LBP) from nonspecific causes and from specific spinal causes remains uncertain.

Methods: We pooled data from Korean National Health Insurance Service-Health Screening Cohort enrolled from 2002 through 2013. A total of 332,189 Korean adults over 40 years of age without pre-existing LBP or any spinal diseases at baseline were followed from 2004 through 2013. Cox proportional-hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between smoking and the incidences of LBP from nonspecific causes, four common causes of low back spinal pain, and a combination of all five categories (all-combined causes), stratified according to gender, after adjustment for confounding factors.

Results: During 3,134,188 person-years of follow-up, there were 127,676 newly developed LBP from all-combined causes, including 78,167 nonspecific causes, 35,682 from intervertebral disc disease, 8320 from spinal instabilities, 7547 from spinal stenosis, 2196 from spondylolisthesis and spondylolysis. In the male cohort, increase in risk of LBP from all-combined causes was noted among former (HR, 1.17; 95% CI), 1.14 to 1.20) and current (HR, 1.14; 95% CI, 1.12 to 1.16) smokers, as compared with never smokers. These included increases in risk of LBP from nonspecific causes among former (HR, 1.19; 95% CI, 1.16 to 1.23) and current (HR, 1.18; 95% CI, 1.15 to 1.21) smokers, from intervertebral disc disease among former (HR, 1.28; 95% CI, 1.23 to 1.33) and current (HR, 1.24; 95% CI, 1.20 to 1.29) smokers, from spinal stenosis among former (HR, 1.41; 95% CI, 1.29 to 1.54) and current (HR, 1.59; 95% CI, 1.47 to 1.72) smokers, from spinal instabilities among former (HR, 1.40; 95% CI, 1.17 to 1.66) and current (HR, 1.32; 95% CI, 1.13 to 1.55) smokers, and from spondylolisthesis and spondylolysis among former (HR, 1.39; 95% CI, 1.27 to 1.52) and current (HR, 1.30; 95% CI, 1.20 to 1.41) smokers. In particular, increase in risk of LBP from spinal stenosis (without increased risks from the other causes and all-combined causes) was noted among current smokers (HR, 1.15; 95% CI, 1.07 to.1.24), as compared with former smokers. In the female cohort, however, there were no significant differences between current and never smokers as well as between former and never smokers in risk of LBP from all-combined causes and from the above specific causes.

Conclusions: Smoking was associated with increased risk of LBP from nonspecific causes, intervertebral disc disease, spinal stenosis, spinal instabilities, spondylolisthesis and spondylolysis, and all-combined causes during 10 years of follow-up in Korean male adults over 40 years of age.