Cigarette Smoking and Its Impact on Spinal Fusions

Many people begin to smoke cigarettes (or use smokeless tobacco) despite published statistics that show its negative impact on health. The adverse effects of smoking include nicotine addiction, increased risk of lung and other types of cancer, higher rates of arteriosclerosis (hardening of the arteries) and heart disease, as well as decreased life expectancy. Plus, there are the effects of secondhand smoke, which are not covered in this article.Female doctor holding a touch pad with a stop smoking emblemCigarette smoking adversely affects many of the body's life-sustaining systems. Photo Source:

  • Tobacco use is the leading preventable cause of death in the United States.
  • Smoking-related deaths in the United States is about 3 times higher than among people who never smoked.
  • Smokeless tobacco can cause cancer.

Cigarettes contain dried tobacco leaves and flavorings, which include more than 4,000 chemicals. Some of these substances are harmless until burned and breathed. Cigarette smoke can be divided into two categories: (1) distinct particles and (2) gases. The following table is a partial list of the substances in cigarette smoke.

Distinct Particles Gases
Aniline Acetone
Benzanthracene Carbon Dioxide
Catechol Carbon Monoxide
Harmane Formaldehyde
Napthalene Hydrazine
Nicotine Hydrogen Cyanide
Phenol Nitrogen Oxides
Quinoline Pyridine
Toluene 3-Vinylpyridine

Cigarettes and the Body
Cigarette smoking adversely affects many of the body's life-sustaining systems, as shown below.

Body System Purpose Cigarettes' Impact
Respiratory Ventilates the lungs, exchanges oxygen and carbon dioxide. Decreases lung function Increases mucous production, increases coughing, and possibly increases infections
Circulatory and blood vessels Delivers oxygen and nutrients to cells and carries away carbon dioxide and waste. Hinders circulation due to plaque deposits and narrowing of blood vessels
Digestive tract Breaks food down into absorbable components to feed the body and eliminates waste. Irritates digestive tract and hinders absorption of nutrients

The Spine and Cigarette Smoking

Bone is a living tissue dependent on the functions and support provided by the other body systems. When these systems are not able to perform normally, bone is unable to rebuild itself. The formation of bone is particularly influenced by physical exercise and hormonal activity, both of which are adversely affected by cigarette smoking.

Many smokers have less physical endurance than nonsmokers, mainly due to decreased lung function. Cigarette smoking reduces the amount of oxygen in the blood and increases the level of harmful substances, such as carbon monoxide. This, combined with the effects of smoking on the heart and blood vessels, can limit the benefits from physical activity.

In men and women, cigarette smoking is known to influence hormone function. Smoking increases estrogen loss in women who are perimenopausal or postmenopausal. This can result in a loss of bone density and lead to osteoporosis. Osteoporosis causes bones to lose strength, becoming more fragile. This silent disease is responsible for many spine and hip fractures in the United States.

Spinal Fusion and Cigarette Smoking

Spinal fusion is a surgical procedure used to join bony segments of the spine (eg, vertebrae). In order for fusion to heal, new bone growth must occur, bridging between the spinal segments. Sometimes fusion is combined with another surgical technique termed spinal instrumentation. Instrumentation consists of different types of medically designed hardware such as rods, hooks, wires, and screws that are attached to the spine. These devices provide immediate stability and hold the spine in proper position while the fusion heals.

Spinal fusion (also termed arthrodesis) can be performed at the cervical, thoracic, or lumbar levels of the spine. It takes months to heal. Your doctor may order post-operative radiographs (x-rays) to monitor the progress of this healing.

The long-term success of many types of spinal surgery is dependent upon successful spinal fusion. In fact, if the fusion does not heal, spinal surgery may have to be repeated. A failed fusion is termed a nonunion or pseudoarthrosis. Spinal instrumentation, although very strong, may even break if nonunion occurs. Needless to say, spine surgeons try to minimize the risk of this happening by prescribing a bone growth stimulator.

Cigarette Smoking and Failed Fusion

Certain factors have been found to affect the success of spinal fusion. Some of these factors include the patient's age, underlying medical conditions (eg, diabetes, osteoporosis), and cigarette smoking. There is growing evidence that cigarette smoking adversely affects fusion. Smoking disrupts the normal function of basic body systems that contribute to bone formation and growth. As mentioned previously, new bone growth is necessary for a fusion to heal.

Research has demonstrated that habitual cigarette smoking leads to the breakdown of the spine to such a degree that fusion is often less successful when compared to similar procedures performed on non-smokers.

Post-Operative Infection

Cigarette smoking compromises the immune system and the body's other defense mechanisms, which can increase the patient's susceptibility to post-operative infection.


Clearly, cigarette smoking is detrimental to spinal fusion. People who are facing fusion or any spine surgery should make every effort to stop smoking. Quitting the habit beforehand will decrease the associated risks and increase the likelihood of a successful spinal fusion surgery.

Updated on: 03/06/19
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