Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
World Neurosurg. 2024 Jul;187:e174-e180. doi: 10.1016/j.wneu.2024.04.060. Epub 2024 Apr 16.
Smoking tobacco cigarettes negatively impacts bone healing after spinal fusion. Smoking history is often assessed based on current smoker and nonsmoker status. However, in current research, smoking history has not been quantified in terms of pack years to estimate lifetime exposure and assess its effects. Our goal was to investigate the influence of smoking history, quantified in pack years, on bony fusion after anterior cervical discectomy and fusion (ACDF).
A retrospective chart review of consecutive patients who underwent ACDF for cervical disc degeneration between September 21, 2017 and October 17, 2018 was conducted. Patient demographics, procedural variables, and postoperative outcomes were analyzed. Multivariate logistic regression analysis was performed to identify predictive factors for bony fusion following ACDF. Receiver operating characteristic curve analysis was used to determine the optimal discrimination threshold for smoking history pack years in association with nonfusion.
Among 97 patients identified, 90 (93%) demonstrated bony fusion on postoperative imaging. Mean number of smoking history pack years was 6.1 ± 13 for the fusion group and 16 ± 21 for the nonfusion group. Multivariate logistic regression analysis suggested that increased pack years of tobacco cigarette smoking was a significant predictor of nonfusion (95% confidence interval, [1.0,1.1], P = 0.045). The receiver operating characteristic curve analysis revealed that 6.1 pack years best stratified the risk for nonfusion (area under the curve, 0.8).
Patients with a history of tobacco cigarette smoking ≥6.1 pack years may have an increased risk of nonfusion after ACDF.
吸烟会对脊柱融合术后的骨骼愈合产生负面影响。吸烟史通常基于当前吸烟者和非吸烟者的状态来评估。然而，在当前的研究中，吸烟史尚未根据吸烟包年来量化，以估计终生暴露量并评估其影响。我们的目标是研究吸烟史（以吸烟包年计算）对前路颈椎间盘切除融合术（ACDF）后骨融合的影响。
对 2017 年 9 月 21 日至 2018 年 10 月 17 日期间连续接受 ACDF 治疗颈椎间盘退变的患者进行回顾性图表审查。分析患者的人口统计学、手术变量和术后结果。进行多变量逻辑回归分析，以确定 ACDF 后骨融合的预测因素。使用接收者操作特征曲线分析确定与非融合相关的吸烟史包年的最佳鉴别阈值。
在确定的 97 例患者中，90 例（93%）术后影像学显示骨融合。融合组的平均吸烟史包年数为 6.1±13，非融合组为 16±21。多变量逻辑回归分析表明，烟草吸烟史增加的包年数是非融合的显著预测因素（95%置信区间，[1.0，1.1]，P=0.045）。接收者操作特征曲线分析表明，6.1 包年最佳分层非融合的风险（曲线下面积，0.8）。
吸烟史≥6.1 包年的患者在接受 ACDF 后可能有更高的非融合风险。
