Effects of Cigarette Smoking on Outcomes in Spine Surgery

rette smoking remains a significant public health concern. Smoking and secondhand smoke exposure account for approximately 480,000 deaths each year in the United States alone. Among other medical complications, smoking has been established to cause cancer, stroke, coronary artery disease, chronic obstructive pulmonary disease, and increases the risk of developing tuberculosis, rheumatoid arthritis, and pregnancy complications. In addition to numerous health consequences, cigarette smoking gives rise to considerable economic costs, including over $170 billion per year in direct medical expenditures. The burden of smoking-related cardiovascular and respiratory disease is well-characterized and remains a focus in the literature, but mounting evidence points to equivalently impactful effects on the musculoskeletal system. Patients’ tobacco use is of particular interest to spine surgeons, as cigarette smoking inhibits vertebral bone healing, increases rates of infection and reoperation, and leads to poor patientreported outcomes.