Berman Daniel, Oren Jonathan H, Bendo John, Spivak Jeffrey
Eastern Virginia Medical School, Norfolk, VA.
Lenox Hill Hospital, Manhattan, NY.
Int J Spine Surg. 2017 Nov 28;11(4):29. doi: 10.14444/4029. eCollection 2017.
Spinal fusion surgery is performed about half a million times per year in the United States and millions more worldwide. It is an effective method for reducing pain, increasing stability, and correcting deformity in patients with various spinal conditions. In addition to being a well-established risk factor for a variety of medical conditions, smoking has deleterious effects on the bone healing of spinal fusions. This review aims to specifically analyze the ways in which smoking affects the outcomes of spinal fusion and to explore ways in which these negative consequences can be avoided.
This article provides a complete understanding of the ways smoking affects spinal fusion from a biochemical and clinical perspective. Recommendations are also provided for ways in which surgeons can limit patient exposure to the most serious negative outcomes associated with cigarette smoking.
STUDY DESIGN/SETTING: This study was a retrospective literature review done using the NCBI database. The research was compiled at NYU Hospital for Joint Diseases and the NYU Center for Musculoskeletal Care.
A comprehensive literature review was done spanning research on a variety of subjects related to smoking and spinal fusion surgery. The biochemistry of smoking and fusion healing were examined in great detail. In addition, both in vivo animal studies and human clinical studies were evaluated to explore fusion success related to the effects of smoking and its biochemical factors on spinal fusion surgery.
Smoking significantly increases the risk of pseudoarthrosis for patients undergoing both lumbar and cervical fusions. In addition to nonunion, smoking also increases the risk of other perioperative complications such as infection, adjacent-segment pathology, and dysphagia. Treatment options are available that can be explored to reduce the risk of smoking-related morbidity, such as nicotine replacement therapy and use of bone morphogenetic proteins (BMPs).
It has been clearly demonstrated from both a biochemical and clinical perspective that smoking increases the rate of perioperative complications for patients undergoing spinal fusion surgery, particularly pseudoarthosis. It has also been shown that there are certain approaches that can reduce the risk of morbidity. The most important recommendation is smoking cessation for four weeks after surgery. In addition, patients may be treated with certain surgical techniques, including the use of BMPs, to reduce the risk of pseudoarthrosis. Lastly, nicotine replacement therapy is an area of continued interest in relation to spinal fusion outcomes and more research needs to be done to determine its efficacy moving forward.
在美国，每年约有50万例脊柱融合手术，全球范围内则有更多。这是一种减轻各种脊柱疾病患者疼痛、增强稳定性和矫正畸形的有效方法。吸烟除了是多种疾病公认的危险因素外，还对脊柱融合的骨愈合有有害影响。本综述旨在具体分析吸烟影响脊柱融合手术效果的方式，并探索避免这些负面后果的方法。
本文从生化和临床角度全面阐述吸烟影响脊柱融合的方式。还为外科医生提供了一些建议，以限制患者接触与吸烟相关的最严重负面后果。
研究设计/地点：本研究是一项使用NCBI数据库进行的回顾性文献综述。研究在纽约大学关节疾病医院和纽约大学肌肉骨骼护理中心进行。
对与吸烟和脊柱融合手术相关的各种主题的研究进行了全面的文献综述。详细研究了吸烟和融合愈合的生物化学过程。此外，对体内动物研究和人体临床研究进行了评估，以探讨与吸烟及其生化因素对脊柱融合手术影响相关的融合成功率。
吸烟显著增加了接受腰椎和颈椎融合手术患者发生假关节的风险。除了骨不连，吸烟还增加了其他围手术期并发症的风险，如感染、相邻节段病变和吞咽困难。可以探索一些治疗选择来降低与吸烟相关的发病风险，如尼古丁替代疗法和使用骨形态发生蛋白（BMPs）。
从生化和临床角度都已清楚表明，吸烟会增加脊柱融合手术患者围手术期并发症的发生率，尤其是假关节。还表明有某些方法可以降低发病风险。最重要的建议是术后四周戒烟。此外，可以采用某些手术技术治疗患者，包括使用BMPs，以降低假关节的风险。最后，尼古丁替代疗法在脊柱融合手术效果方面仍是一个持续关注的领域，需要开展更多研究以确定其未来的疗效。
