P109. Tobacco use is associated with worse patient-reported outcomes following elective cervical spine surgery (original) (raw)
Related papers
2010
Background Smoking is associated with reduced fusion rates after anterior cervical decompression and arthrodesis procedures. Posterior cervical arthrodesis procedures are believed to have a higher fusion rate than anterior procedures. Questions/purposes We asked whether smoking (1) would reduce the fusion rate in posterior cervical procedures; and (2) be associated with increased pain, decreased activity level, and a decreased rate of return of work as compared with nonsmokers. Methods We retrospectively reviewed 158 patients who had a posterior cervical fusion with lateral mass instru-mentation and iliac crest bone grafting between 2003 and 2008. Fusion rates and Odom Criteria grades were com-pared among smokers and nonsmokers. The minimum followup was 3 months (average, 14.5 months; range, 3–72 months). Results Smokers and nonsmokers had similar fusion rates (100%). Although 80 % of patients had Odom Criteria Grade I or II, smokers were five times more likely to have Grade III or ...
National Trends in Outpatient Surgical Treatment of Degenerative Cervical Spine Disease
Global Spine Journal, 2014
Retrospective population-based observational study. Objective To assess the growth of cervical spine surgery performed in an outpatient setting. Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revision Clinical Modification (ICD-9-CM) codes were used to identify operations for degenerative cervical spine diseases in adults (age > 20 years). Disposition and complication rates were examined. Results There was an increase in cervical spine surgeries performed in an ambulatory setting during the study period. Anterior cervical diskectomy and fusion accounted for 68% of outpatient procedures; posterior decompression made up 21%. Younger patients predominantly underwent anterior fusion procedures, and patients in the eighth and ninth decades of life had more posterior decompressions. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The majority (>99%) of patients were discharged home following ambulatory surgery. Conclusions Recently, the number of cervical spine surgeries has increased in general, and more of these procedures are being performed in an ambulatory setting. The majority (>99%) of patients are discharged home but the nature of analyzing administrative data limits accurate assessment of postoperative complications and thus patient safety. This increase in outpatient cervical spine surgery necessitates further discussion of its safety.
Effects of smoking on cervical disc arthroplasty
Journal of Neurosurgery: Spine, 2019
OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at ea...
Clinical Orthopaedics & Related Research, 2010
Background Smoking is associated with reduced fusion rates after anterior cervical decompression and arthrodesis procedures. Posterior cervical arthrodesis procedures are believed to have a higher fusion rate than anterior procedures. Questions/purposes We asked whether smoking (1) would reduce the fusion rate in posterior cervical procedures; and (2) be associated with increased pain, decreased activity level, and a decreased rate of return of work as compared with nonsmokers. Methods We retrospectively reviewed 158 patients who had a posterior cervical fusion with lateral mass instrumentation and iliac crest bone grafting between 2003 and 2008. Fusion rates and Odom Criteria grades were compared among smokers and nonsmokers. The minimum followup was 3 months (average, 14.5 months; range, 3-72 months). Results Smokers and nonsmokers had similar fusion rates (100%). Although 80% of patients had Odom Criteria Grade I or II, smokers were five times more likely to have Grade III or IV with considerable limitation of physical activity. Age, gender, and diagnosis did not influence fusion rates or the Odom Criteria grade. Conclusions In contrast to the effect of smoking on anterior cervical fusion, we found smoking did not decrease posterior cervical fusion with lateral mass instrumentation and iliac crest bone grafting. Posterior cervical fusion with lateral mass instrumentation should be considered over anterior procedures in smokers if the abnormality can appropriately be addressed from a posterior approach. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Outpatient Surgery in the Cervical Spine: Is It Safe?
Evidence-Based Spine-Care Journal, 2014
Study Design Systematic review. Study Rationale As the length of stay after cervical spine surgery has decreased substantially, the feasibility and safety of outpatient cervical spine surgery come into question. Although minimal length of stay is a targeted metric for quality and costs for medical centers, the safety of outpatient cervical spine surgery has not been clearly defined. Objective The objective of this article is to evaluate the safety of inpatient versus outpatient surgery in the cervical spine for adult patients with symptomatic or asymptomatic degenerative disc disease. Methods A systematic review of the literature was undertaken for articles published through February 19, 2014. Electronic databases and the bibliographies of key articles were searched to identify comparative studies evaluating the safety of inpatient versus outpatient surgery in the cervical spine. Spinal cord stimulation, spinal injections, and diagnostic procedures were excluded. Two independent reviewers assessed the strength of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, and disagreements were resolved by consensus. Results Five studies that met the inclusion criteria were identified. One study reported low risk of hematoma (0% of outpatients and 1.6% of inpatients). Two studies reported on mortality and both reported no deaths in either group following surgery. Dysphagia risks ranged from 0 to 10% of outpatients and 1.6 to 5% of inpatients, and infection risks ranged from 0 to 1% of outpatients and 2 to 2.8% of inpatients. One study reported that no (0) outpatients were readmitted to the hospital due to a complication, compared with four inpatients (7%). The overall strength of evidence was insufficient for all safety outcomes examined. Conclusion Though the studies in our systematic review did not suggest an increased risk of complication with outpatient cervical spine surgery, the strength of evidence to make a recommendation was insufficient. Further study is needed to more clearly define the role of outpatient cervical spine surgery.
Journal of Tepecik Education and Research Hospital, 2015
Objective: At present, the use of a cervical cage has become an accepted and widely practiced surgical intervention for the treatment of cervical disc disease (CDD). Polycarbon PEEK cage has been used in the treatment of cervical disc disease as a spacer with good long-term outcomes. Methods: A retrospective study was performed with 16 consecutive patients who underwent single-level anterior cervical discectomy and fusion (ACDF) with a PEEK cage. Lateral plain radiographs were obtained both preoperatively, and at postoperative two years. Patients were followed for a minimum of 24 months. Results: The surgical procedures used were technically successful for all patients and there were no major complications related to anesthesia or the overall surgical procedure. The mean intervertebral disc height (DH) was 4.6±1.4 mm preoperatively, and height was 4.5±1.4 mm at the postoperative 24-month of the follow-up period. The mean angle of lordosis (LA) was 14.5±16.8° preoperatively and 17.5±13.5° at the 24-month follow-up. The mean segment angle (SA) was13.4±15.2º preoperatively, and 12.6±11.9º at the 24 month of the postoperative follow-up period. There was no PEEK cage dislodgment or failure. The clinical symptoms improved in all monitored patients. Conclusion: ACDF is an effective way for the treatment of CDD. Using a cage prevents segmental collapse. This technique can also put AL, SA and SH within normal limits, so postoperative pain reduces and quality of life of the patients improve. Long-term clinical outcome of the stand-alone cages used in the surgical treatment of one cervical disc disease is satisfactory.
Outcomes Following Anterior Cervical Discectomy and Fusion
Journal of Spinal Disorders & Techniques, 2005
Objective: Anterior cervical discectomy and fusion (ACDF) is a successful procedure for the degenerative cervical spine. One goal of the fusion is to restore the loss of disc height that results from the degenerative process. Whereas cervical alignment improves with increased disc height, the ideal graft size used for disc space restoration is unknown. Few studies have examined the relationships between these changes in cervical alignment and clinical outcomes. Methods: All patients underwent a single-level ACDF at the authors' institution. Radiographs at early and final follow-up were examined, and three measurements were made: disc height, disc space angulation, and spinous process distance. These radiographic measurements were correlated with Visual Analog Scales (VASs) for neck and arm pain and Oswestry Disability Index (ODI). Results: There were significant changes in disc height (5.3 vs 7.0 mm) as well as disc space angulation (3.3°vs 0.1°). Reduction in neck pain VAS score (6.7 vs 3.2) and arm pain VAS score (5.1 vs 2.3) was significant. ODI scores were not statistically different, but improvement of 20.1% was observed. Correlations between radiographic parameters and clinical outcomes were moderate to low, and none was significant. Conclusions: While restoration of cervical alignment and disc height is important, clinical results are critical in analysis of outcomes following ACDF. We have shown that although clinical outcomes remain good, there does not appear to be any strong correlation with radiographic results. Emphasis on restoration of cervical alignment appears justified, but its influence on clinical outcomes may be overstated.
International Journal of Spine Surgery, 2020
Background: Smoking is a known predictor of negative outcomes in spinal surgery. However, its effect on the functional outcomes and revision rates after ADR is not well-documented. This study is a retrospective analysis of prospectively collected data at a major tertiary center. The objective was to elucidate the impact of smoking on functional outcomes in cervical artificial disc replacement (ADR). Methods: Patients who underwent cervical ADR for myelopathy or radiculopathy from 2004 to 2015 with a minimum of 2 years of follow-up were included in the study. Patient function was assessed using Short Form-36 (SF-36), American Association of Orthopaedic Surgery (AAOS) cervical spine, and Japanese Orthopaedic Association (JOA) scoring systems preoperatively and at 2 years postoperatively. Incidence of further surgery on affected and adjacent segments was analyzed as well. Results: A total of 137 patients were included in the study, consisting of 117 nonsmokers and 20 smokers. There were 60 patients who presented with myelopathy and 77 with radiculopathy. The mean age of smokers was 42.6 years, compared with 46.4 years in the nonsmoker group (P , .01). Statistical improvement was noted in postoperative range of motion, as well as AAOS, SF-36, and JOA scores in both groups, with no difference between groups at 2 years of follow-up. A total of 84.2% of nonsmokers and 87.5% of smokers reported as surgery having met their expectations. A total of 5 of 117 nonsmokers (5.1%) and 4 of 20 smokers (20%) needed revision surgery (P ¼ .018). Three of the 4 smokers who required surgery for adjacent or multisegment disease, whereas only 2 of the nonsmokers needed an operation for adjacent segment disease. Conclusions: Our analysis indicates that there is no difference in functional outcome or patient satisfaction between smokers and nonsmokers. Smokers have a higher chance of revision surgery after an artificial disc replacement compared with nonsmokers at 2 years. Level of Evidence: 3.