565 - Influence of Smoking on Two Level Anterior Cervical Discectomy and Fus...

Oral Posters: Cervical

Presented by: S. Niedermeier - View Audio/Video Presentation (Members Only)


E. Cerier(1), N. Jain(2), S. Lenobel(1), E. Yu(2), S. Niedermeier(1)

(1) Ohio State University, Columbus, OH, United States
(2) Ohio State University, Orthopaedics, Columbus, OH, United States


Introduction: Studies have demonstrated decreased fusion rates, greater collapse and increased interspace angle loss with multi-level cervical fusions in smoking patients. There is less convincing evidence on the negative effects of smoking on fusion in a single-level ACDF, while there are no specific reports of the impact of smoking in a two-level ACDF. Adding knowledge of this impact may help in patient education about the risks of a poor outcome following surgery.

Methods: Patients ≥18 years of age (no upper limit at the time of the procedure) who had a two-level ACDF to treat cervical radiculopathy or myelopathy, performed at a single institution between January 2008 and September 2015 were enrolled. Demographic and pre-operative clinical information was recorded for all patients. Patients were classified as smokers if they currently smoked at the time of the procedure or had quit within 6 months of the procedure. Fusion status was assessed using standard cervical spine radiographs. Patient reported outcomes were captured with Neck Disability Index (NDI) questionnaires. Results were analyzed using the Chi-square test to compare fusion status between smokers and nonsmokers. NDI scores were compared by a one-way analysis of variance (ANOVA) and an unpaired t-test, as appropriate.

Results: A total of 61 patients met our inclusion criteria, out of which 23 were smokers at the time of procedure. The mean age of smokers (n=23) was 47.7 ±8.2 years and for non-smokers (n=38) was 52.10 ±8.6 years (p >0.05). The median follow-up time was 12 months. 11 smokers (61%) and 17 (53%) non-smokers demonstrated definite evidence of fusion. Five (28%) smokers and 13 (41%) non-smokers showed delayed fusion, and two (11%) smokers and two (6%) non-smokers demonstrated evidence of nonunion. The difference in fusion status between smokers and non-smokers was not statistically significant (p=0.58). Pre-operatively, smokers had an average NDI of 62.19, with a 13.6 %, 7.4 %, and 27.6 % decrease at 3, 6, and 12 months respectively. Non-smokers had a pre-operative average NDI of 45.37, with a 29 %, 53.9 % and 64.5 % decrease at 3, 6, and 12 months respectively.

Conclusion: Smoking was not associated with a decreased rate of radiographic fusion. However, smokers had lower and less progressive improvements of NDI scores compared to non-smokers. Pre-operative counseling should include education about risks of inferior clinical outcomes in smokers independent of fusion status.