Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate.
This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs.
An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers.
The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.
[Show abstract][Hide abstract] ABSTRACT: Study Design. Retrospective study.Objective. To study the impact of smoking status on postoperative complications and pseudoarthrosis in adult patients undergoing posterolateral fusion (PLF) of the lumbar spine.Summary of Background Data. Results of studies analyzing the impact of smoking on complication and pseudoarthrosis rates following spine surgery are conflicting.Methods. A retrospective medical record review was performed to identify all adult patients who underwent single and two-level instrumented PLF without interbody devices for degenerative spine disease in a 21-year period at a single institution. Patients were divided into smokers and non-smokers. The main outcome variables were development of at least one post-operative complication and development of pseudoarthrosis.Results. A total of 281 patients underwent single or two-level PLF in the 21-year period. Of these, 231 (82.21%) patients were non- smokers and 50 (17.9%) smokers. For patients undergoing single-level PLF, complication rates in non-smokers (3.57%) vs. smokers (7.69%) were not significantly different (P = 0.353); pseudoarthrosis in non-smokers occurred in 9.82% of cases compared to 7.69% in the smoker's group (P = 0.738). Non-smokers undergoing two-level PLF had complication rates of 6.72%, compared to 4.17% in smokers (P = 0.638), but pseudoarthrosis rates were significantly higher in the smoker's group compared to non-smokers (29.17% vs. 10.92%; P = 0.019). Patients were followed-up for an average of 53.5 months.Conclusion. The findings in the present study suggest that smoking has a significant impact on pseudoarthrosis rates following two-level PLF of the lumbar spine, but not necessarily on single-level PLF.
[Show abstract][Hide abstract] ABSTRACT: Anterior cervical decompression and fusion is a dependable and successful treatment option for single-level cervical radiculopathy. However, due to the deleterious effects a fusion has on the kinematics of the adjacent level, artificial cervical disc arthroplasty has become a favorable alternative. Even though the short-term clinical data does not strongly support that a total disc arthroplasty decreases the risk of adjacent segment disease, it does have equal and in some aspects greater clinical outcomes than a fusion. Understanding the biomechanics, indications, outcomes, complications, and implant design will help one better decide which procedure is optimal for a given patient.
Seminars in Spine Surgery 09/2014; 26(3). DOI:10.1053/j.semss.2014.08.007
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