How To Keep Your Spine Healthy


Quit Smoking

Numerous studies have demonstrated significant direct relationships between smoking and back pain. Other studies identify smoking as a strong predictor for slow recovery or pseudoarthrosis, the failure of solid fusions, following spinal surgery. The mechanisms by which these occur may be multi-faceted, from decreased exercise among smokers to disruption of cellular metabolism in the vertebral bodies and discs.

Article: Smoking is a Leading Risk Factor for Degenerative Disc Disease (DDD)

Although genetic predisposition is the #1 risk factor, a growing number of studies indicate that smoking is a leading risk factor for DDD, both in the lumbar discs (lower back) and cervical discs (neck). Research suggests that smokers have a 3-4 times higher risk of developing DDD and that smoking can exacerbate pre-existing disc degeneration.

Nicotine deprives disc cells of vital nutrients. In addition to nicotine, smokers introduce carbon monoxide into the blood stream and from there into body tissues. These poisons inhibit the discs’ ability to absorb the nutrients they need from the blood. The result can be prematurely dehydrated, less pliable discs – degenerated discs.

As the discs become more and more malnourished, there is a greater risk of a ruptured disc. This occurs when the disc contents break through the outer layer of the disc, often impinging on nerves and causing great pain, numbness, and in some cases nerve damage in the legs or arms. These same poisons also interfere with the absorption of calcium, leading to a compromised vertebral structure.

Coughing, which is more prevalent among smokers, can also add to the risk. Coughing causes increased pressure between discs. This puts added strain on the spine and discs, creating greater risk of disc bulges and ruptures, especially in a spine already weakened because of smoking-related toxins.

Inactivity, which is also frequently associated with the smoker’s lifestyle, can result in a higher frequency of back pain in general, and unfortunately pain associated with DDD can make an active lifestyle more difficult to enjoy.

Anyone who is still smoking by the time this surgery is required is strongly advised to quit smoking prior to surgery. Many surgeons will not perform the surgery until the patient has been smoke-free for several months. Smoking impedes new bone growth, which is instrumental in the success of spinal fusion. Researchers have determined that nicotine is a bone toxin and as a result, the failure rate for many types of fusions can be 3-4 times higher for smokers.

More research is being done to study the relationship between smoking and DDD, but there is ample evidence already to suggest that quitting smoking now may reduce the risk of developing or exacerbating DDD.

To those who might be contemplating quitting and wondering if you have another 10, 20, or 30 years to smoke before you do any real or lasting damage, please think again and don’t take the gamble. It’s so risky, and I urge you to think about what you’re putting on the line. For every warning actually listed on a pack of cigarettes there are many more illnesses, diseases, and complications that smoking can cause. Quit now, and at least know that from this day forward you are doing all you can to protect your health and well-being.

Article: Smoking Threatens Orthopaedic Outcomes

Although the prevalence of smoking has decreased dramatically in the United States during the past 50 years, this decline has not translated into a decline in the health problems associated with smoking. The deleterious effects of smoking on cardiovascular and pulmonary function are well known, as are the carcinogenic properties, and physicians in these disciplines have been at the forefront of smoking cessation efforts for their patients.

At the AAOS Now-sponsored Perioperative Smoking Cessation Forum, held in San Francisco in February, researchers noted that patients who quit smoking have improved outcomes for surgical and nonsurgical treatments of musculoskeletal conditions and injuries. Their studies provide convincing reasons for orthopaedic surgeons to become involved in helping patients to quit smoking.

Basic science studies
Several basic science studies have documented the effects of tobacco use on the musculoskeletal system at the cellular and molecular levels, including the development or worsening of intervertebral disk degeneration, osteoporosis, arthritis, and delayed ligament healing.

In a study replicating long-term cigarette use in humans, mice exposed to cigarette smoke had reduced disk matrix protein (proteoglycans). The intervertebral disks of young rats exposed to cigarette smoke developed disk cracks and fibrosis. In rabbits, exposure to cigarette smoke resulted in delayed healing and decreased torsional strength of the tibia after tibial lengthening.

Studies have also found that cigarette smoke condensate augmented the induction and development of arthritis and antibody levels against collagen. Reported effects at the molecular level include decreases in cellular density and type I collagen, DNA damage, an increase in inflammatory cytokines, loss of the extracellular matrix, cellular senescence, cell death, and decreased cell proliferation.

Not only does smoking affect outcomes of spinal surgery, it appears to contribute to the development of spinal conditions that require surgery. Associations have been found between the number of pack-years of smoking and the development of lumbar disk herniation and between smoking and the progression of spondylolisthesis, an earlier onset of inflammation, and poor function and quality of life in smokers.

The association between tobacco use and worse outcomes and more frequent complications has also been confirmed in studies of total joint arthroplasty, fracture healing, hand and foot surgery, ligament and cartilage repair, and the development of osteoporosis and rotator cuff pathology. Several studies have reported increased risks of surgical site infections and wound breakdown after total knee (TKA) or total hip arthroplasty (THA) in smokers. Smokers have a greater risk of implant loosening, longer operative times, and higher hospital charges than nonsmokers.

The delayed fracture healing suggested by basic science studies also has been exhibited in clinical studies. A study of patients with open tibial fractures found that smokers had a longer time to fusion, more complications, and a lower union rate than nonsmokers. The risk of impaired bone healing in tibial shaft fractures has been estimated at 3 to 18 times higher in smokers. The results of a multicenter, randomized, controlled trial found that the odds of having a complication after a fracture of the upper or lower extremity was 2.5 times higher in smokers than in nonsmokers and rates of superficial infection in smokers were more than double those in nonsmokers.

A 2010 Cochrane Database Review concluded that smoking cessation interventions beginning 4 to 8 weeks before surgery could significantly reduce postoperative complications. 

Most patients, if properly informed, want help to quit or reduce smoking before their surgery. An informal survey of patients who smoked found that 85 percent would be willing to start a supervised smoking cessation program before surgery. In another group of patients facing foot or ankle surgery, 64 percent quit smoking and 16 percent reduced the rate of their smoking with encouragement and counseling before surgery.

Although the most effective smoking cessation program has yet to be determined, most use some combination of the following:

  • counseling
  • a dedicated “quitline”
  • regular follow-up contact
  • nicotine replacement therapy (NRT)
  • pharmaceutical support

Maintain An Ideal Body Weight

For people with many types of back problems, regular exercise and, when necessary, weight loss, can help ease existing back problems and prevent future ones.

Obesity and Extra Weight can Cause Low Back Pain

Along with other health issues that arise from having an unhealthy weight level, obese and overweight patients have an increased risk for back pain, joint pain and muscle strain1. In particular, overweight patients are more likely to experience problems in their low back than patients at a healthy weight level. This is especially true for people with extra weight around their midsection as the extra weight pulls the pelvis forward, strains the low back and creates low back pain.

In addition to muscle strain, spinal structures such as the discs can be negatively impacted by obesity. Patients with significant excess weight also may experience sciatica and low back pain from a herniated disc or from a pinched nerve if the discs have been damaged from compensating for the extra weight.