David J Kusin1, Uri M Ahn, Nicholas U Ahn. 1. *Case Western Reserve University School of Medicine, Cleveland, OH †New Hampshire Neurospine Institute, Bedford, NH; and ‡Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH.
Abstract
STUDY DESIGN: Retrospective cohort. OBJECTIVE: The purpose of this study was to compare outcomes of surgical treatment of cervical myelopathy between smokers and nonsmokers as assessed by the Nurick score. SUMMARY OF BACKGROUND DATA: The harmful effects of smoking on healing have been well established. However, the effect of smoking on postoperative outcomes for cervical myelopathy has not been specifically evaluated. METHODS: The medical records of 212 patients who underwent surgery for cervical spondylotic myelopathy were reviewed. Inclusion criteria were the diagnosis of cervical spondylotic myelopathy with a Nurick score, surgical intervention, and at least 2 years of follow-up. The patients were categorized into 2 groups according to smoking status and stratified according to pack years and packs per day. Age at presentation, sex, preoperative and postoperative Nurick score, duration of symptoms preoperatively, duration of follow-up, procedure performed, surgical approach, number of levels fused, diabetes status, cocaine use, ethanol use, preoperative magnetic resonance imaging signal change, and whether the patient belonged to the Veterans Administration (VA) were recorded. Analysis was done using simple linear regression and multiple regression. RESULTS: Univariate analysis demonstrated a postoperative improvement in nonsmokers of 1.53 points on the Nurick scale compared with 0.6 points in smokers (P < 0.001). There is a progressive decrease in improvement as the number of pack years and packs per day increase (P < 0.001). There is a greater improvement in Nurick score with greater (worse) preoperative score but only in patients with fewer than 25 pack years. Smoking status is not associated with preoperative Nurick score. CONCLUSION: Smoking status is associated with poor improvement in Nurick score after surgical treatment of cervical myelopathy. Smoking may have a directly toxic effect on the intrinsic healing capability of the spinal cord, particularly beyond 25 pack years. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective cohort. OBJECTIVE: The purpose of this study was to compare outcomes of surgical treatment of cervical myelopathy between smokers and nonsmokers as assessed by the Nurick score. SUMMARY OF BACKGROUND DATA: The harmful effects of smoking on healing have been well established. However, the effect of smoking on postoperative outcomes for cervical myelopathy has not been specifically evaluated. METHODS: The medical records of 212 patients who underwent surgery for cervical spondylotic myelopathy were reviewed. Inclusion criteria were the diagnosis of cervical spondylotic myelopathy with a Nurick score, surgical intervention, and at least 2 years of follow-up. The patients were categorized into 2 groups according to smoking status and stratified according to pack years and packs per day. Age at presentation, sex, preoperative and postoperative Nurick score, duration of symptoms preoperatively, duration of follow-up, procedure performed, surgical approach, number of levels fused, diabetes status, cocaine use, ethanol use, preoperative magnetic resonance imaging signal change, and whether the patient belonged to the Veterans Administration (VA) were recorded. Analysis was done using simple linear regression and multiple regression. RESULTS: Univariate analysis demonstrated a postoperative improvement in nonsmokers of 1.53 points on the Nurick scale compared with 0.6 points in smokers (P < 0.001). There is a progressive decrease in improvement as the number of pack years and packs per day increase (P < 0.001). There is a greater improvement in Nurick score with greater (worse) preoperative score but only in patients with fewer than 25 pack years. Smoking status is not associated with preoperative Nurick score. CONCLUSION: Smoking status is associated with poor improvement in Nurick score after surgical treatment of cervical myelopathy. Smoking may have a directly toxic effect on the intrinsic healing capability of the spinal cord, particularly beyond 25 pack years. LEVEL OF EVIDENCE: 3.
Authors: Lee Wen-Shen; Maksim Lai Wern Sheng; William Yeo; Tan Seang Beng; Yue Wai Mun; Guo Chang Ming; Mohammad Mashfiqul Arafin Siddiqui Journal: Int J Spine Surg Date: 2020-12-29
Authors: Phillip Grisdela; Zorica Buser; Anthony D'Oro; Permsak Paholpak; John C Liu; Jeffrey C Wang Journal: Eur Spine J Date: 2017-05-09 Impact factor: 3.134
Authors: Ian F Caplan; Saurabh Sinha; Benjamin Osiemo; Scott D McClintock; James M Schuster; Harvey Smith; Gregory Glauser; Nikhil Sharma; Ali K Ozturk; Zarina S Ali; Neil R Malhotra Journal: Int J Spine Surg Date: 2020-04-30
Authors: Ian Caplan; Saurabh Sinha; James Schuster; Matthew Piazza; Gregory Glauser; Benjamin Osiemo; Scott McClintock; William C Welch; Nikhil Sharma; Ali Ozturk; Neil Rainer Malhotra Journal: Asian J Neurosurg Date: 2019 Apr-Jun