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Smokers Show Less Improvement Than Nonsmokers Two Years after Surgery for Lumbar Spinal Stenosis: A study of 4555 Patients from the Swedish Spine Register
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. (Ortopedi)
2011 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, no 13, 1059-1064 p.Article in journal (Refereed) Published
Abstract [en]

Study Design. A cohort study based on the Swedish Spine Register.

Objective. To determine the relation between smoking status and disability after surgical treatment for lumbar spinal stenosis.

Summary of Background Data. Smoking and nicotine have been shown to inhibit lumbar spinal fusion and promote disc degeneration. No association, however, has previously been found between smoking and outcome after surgery for lumbar spinal stenosis. A large prospective study is therefore needed.

Methods. All patients with a completed 2-year follow-up in the Swedish Spine Register operated for central lumbar stenosis before October 1, 2006 were included. Logistic regression was used to assess the association between smoking status and outcomes.

Results. Of 4555 patients enrolled, 758 (17%) were current smokers at the time of surgery. Smokers had an inferior health-related Quality of Life at baseline. Nevertheless, adjusted for differences in baseline characteristics, the odds ratio (OR) for a smoker to end up dissatisfied at the 2-year follow-up after surgery was 1.79 [95% confidence interval (CI) 1.51-2.12]. Smokers had more regular use of analgesics (OR 1.86; 95% CI 1.55-2.23). Walking ability was less likely to be significantly improved in smokers with an OR of 0.65 (95% CI 0.51-0.82). Smokers had inferior Quality of Life also after taking differences before surgery into account, either when measured with the Oswestry Disability Index (ODI; P < 0.001), EuroQol (P < 0.001) or Short Form (36) Health Survey (SF-36) BP and SF-36 PF (P < 0.001). The differences in results between smokers and nonsmokers were evident, irrespective of whether the decompression was done with or without spinal fusion.

Conclusion. Smoking is an important predictor for 2-year results after surgery for lumbar spinal stenosis. Smokers had less improvement after surgery than nonsmokers.

Place, publisher, year, edition, pages
2011. Vol. 36, no 13, 1059-1064 p.
Keyword [en]
smoking, spinal stenosis, surgical results
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-146290DOI: 10.1097/BRS.0b013e3181e92b36ISI: 000290750200011PubMedID: 21224770OAI: oai:DiVA.org:uu-146290DiVA: diva2:397928
Available from: 2011-02-16 Created: 2011-02-16 Last updated: 2015-10-27Bibliographically approved
In thesis
1. On Surgery for Lumbar Spinal Stenosis
Open this publication in new window or tab >>On Surgery for Lumbar Spinal Stenosis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The incidence of lumbar spinal stenosis (LSS) is steadily rising, mostly because of a noticeably older age structure. In Sweden, LSS surgery has increased continuously over the years and is presently the most common argument to undergo spine surgery. The purpose of the surgery is to decompress the neural elements in the stenotic spinal canal. To avoid instability, there has been a tradition to do the decompression with a complementary fusion, especially if degenerative spondylolisthesis is present preoperatively.

The overall aims of this thesis were to evaluate which method of surgery that generally can be considered to give sufficiently good clinical results with least cost to society and risk of complications and to determine whether there is a difference in outcome between smokers and non-smokers.

The Swespine Register was used to collect data on clinical outcome after LSS surgery. In two of the studies, large cohorts were observed prospectively with follow-up after 2 years. Data were analysed in a multivariate model and logistic regression. In a randomised controlled trial (RCT, the Swedish Spinal Stenosis Study), 233 patients were randomised to either decompression with fusion or decompression alone and then followed for 2 years. The consequence of preoperative degenerative spondylolisthesis on the results was analysed and a health economic evaluation performed. The three-dimensional CT technique was used in a radiologic biomechanical pilot study to evaluate the stabilising role of the segmental midline structures in LSS with preoperative degenerative spondylolisthesis by comparing laminectomy with bilateral laminotomies.

Smokers, in comparison with non-smokers, showed less improvement after surgery for LSS. Decompression with fusion did not lead to better results compared with decompression alone, no matter if degenerative spondylolisthesis was present preoperatively or not; nor was decompression with fusion found to be more cost-effective than decomression alone. The instability caused by a decompression proved to be minimal and removal of the midline structures by laminectomy did not result in increased instability compared with the preservation of these structures by bilateral laminotomies.

In LSS surgery, decompression without fusion should generally be the treatment of choice, regardless of whether preoperative degenerative spondylolisthesis is present or not. Special efforts should be targeted towards smoking cessation prior to surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 66 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1135
spinal stenosis, decompression, fusion, degenerative spondylolisthesis
National Category
Research subject
Orthopaedics; Neurosurgery
urn:nbn:se:uu:diva-262525 (URN)978-91-554-9340-0 (ISBN)
Public defence
2015-11-06, Eva Netzeliussalen, Blåsenhus, von Kraemers Allé 1A, Uppsala, 13:00 (Swedish)
Available from: 2015-10-15 Created: 2015-09-16 Last updated: 2015-10-27

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