Cerier Emily, Jain Nikhil, Lenobel Scott, Niedermeier Steven R, Stammen Kari, Yu Elizabeth
Department of Orthopaedics, College of Medicine, The Ohio State University.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
Clin Spine Surg. 2019 May;32(4):175-178. doi: 10.1097/BSD.0000000000000765.
Retrospective cohort study.
To study the impact of smoking on patient-reported outcomes after primary 2-level anterior cervical discectomy and fusion (ACDF).
Previous studies have found suboptimal outcomes after multilevel ACDF in smoking patients. There is contrasting evidence on the negative effects of smoking in single-level ACDF, while there are no specific reports in 2-level ACDF. Adding knowledge of smoking's impact on patient-reported outcomes (PRO) will help in tailored patient counseling and preoperative education.
Patients 18 years of age or older at a single academic institution who underwent 2-level ACDF to treat cervical radiculopathy and/or myelopathy between September 2013 and September 2015 were included. PRO was studied using the neck disability index (NDI) preoperatively, and at 3, 6, 12 months. χ test for qualitative variables, and one-way analysis of variance (ANOVA) and unpaired t test for quantitative variables were used for statistical analysis.
A total of 61 patients, of which 23 (37.7%) were classified as smokers were included. Demographic and clinical profile of patients was similar both groups. Preoperatively, smokers had a mean NDI of 62.8±12.7 with a 17.5%, 18.7%, and 27.7% decrease at 3, 6, and 12-months, respectively. Nonsmokers had a mean preoperative NDI of 45.9±15.3, with a 36.4%, 61.2% and 65.4% decrease at 3, 6, and 12-months, respectively. Despite higher baseline NDI in smokers, improvement in NDI reached significance at 3-months in nonsmokers. In smokers, the improvement in NDI was slower and reached significance at 12-months. The radiographic fusion status at latest follow-up was similar in smokers and nonsmokers (P=0.67).
Smokers had lower improvements in NDI scores compared to nonsmokers after a 2-level ACDF. Preoperative counseling before 2-level ACDF should include education about risks of inferior clinical outcomes in smokers independent of fusion status.
回顾性队列研究。
研究吸烟对初次二级前路颈椎间盘切除融合术（ACDF）后患者报告结局的影响。
既往研究发现吸烟患者多级ACDF术后效果欠佳。关于吸烟在单级ACDF中的负面影响存在相互矛盾的证据，而在二级ACDF中尚无具体报道。了解吸烟对患者报告结局（PRO）的影响将有助于进行针对性的患者咨询和术前教育。
纳入2013年9月至2015年9月期间在单一学术机构接受二级ACDF治疗颈椎神经根病和/或脊髓病的18岁及以上患者。术前、术后3个月、6个月和12个月使用颈部功能障碍指数（NDI）研究PRO。定性变量采用χ检验，定量变量采用单因素方差分析（ANOVA）和非配对t检验进行统计分析。
共纳入61例患者，其中23例（37.7%）被归类为吸烟者。两组患者的人口统计学和临床特征相似。术前，吸烟者的平均NDI为62.8±12.7，在3个月、6个月和12个月时分别下降17.5%、18.7%和27.7%。非吸烟者术前平均NDI为45.9±15.3，在3个月、6个月和12个月时分别下降36.4%、61.2%和65.4%。尽管吸烟者的基线NDI较高，但非吸烟者在3个月时NDI的改善达到显著水平。在吸烟者中，NDI的改善较慢，在12个月时达到显著水平。吸烟者和非吸烟者在最新随访时的影像学融合状态相似（P = 0.67）。
二级ACDF术后，吸烟者的NDI评分改善低于非吸烟者。二级ACDF术前咨询应包括告知吸烟者临床结局较差的风险，且与融合状态无关。
