Nicotine, and its 4,000 other chemical friends found in cigarettes, are known to slow wound and bone healing. This may lead to severe adverse outcomes in spinal injuries, degenerative conditions and elective spine surgery. For the purposes of this discussion I will mostly refer to tobacco abuse as “smoking”. If you “chew” or “vape”, keep reading because you are in the same boat!
Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin and bone. This can cause “tissue ischemia” and impair healing of injured tissue which leads to infection. Spine is the foundation for the body; consider it the “tree trunk” that supports all other activities. It does not have large blood vessels to draw nutrients from, but instead it is fed by millions of smaller vessels. These vessels are most susceptible to the effects of Nicotine because they squeeze closed after its consumption. There are also other chemicals such as Carbon Monoxide and Hydrogen Cyanide that inhibit the bodies natural reaction to injury which can further slow healing.
In the case of a fusion, you have a certain amount of time to “fuse” the bony segments before your body will essentially give up and wall the areas off into separate segments. This leads to what is called a “non-union” and/or “hardware failure” which may lead to additional pain and the need for revision surgery. It is generally felt that in a healthy individual, a fusion would be complete in 12 to 18 months. In patients who consume tobacco, we know this process takes much longer and the risk of a non-union is dramatically increased.
Okay, Okay time to quit. You may have tried before and FAILED! Well don’t be so hard on yourself. Quitting is a process with many ups and downs. Here at Summit Spine, we understand that this is no easy task. Successful smoking cessation is all about preparation and patience. First and foremost is to understand that you have two addictions; physical and habitual. Often times when people fail quitting, it is because they are only addressing and planning for one of these.
Physical Addition is the area most people focus on. This is often treated with medication. There are several products available to consider.
- Wellbutrin is a mood stabilizer that may be effective in managing the anxiety and mood swings which are common when withdrawing from nicotine.
- Nicotine patches and gum can also be effective. They allow you to taper the amount of nicotine in your body by “weaning off” the chemicals. Please keep in mind though that the nicotine from patches or gum still slow the healing of the bone and tissue, therefore plan ahead to ensure you’re done using them before surgery.
- Chantix is an excellent new medication which works on both the physical and habitual addictions. This medication binds to the nicotine receptors in your brain to release the “happy chemicals” you get from a cigarette. It also prevents the nicotine you consume from binding to those receptors so you don’t get anything from your tobacco. This leads to less interest in a dip or smoke (habitual dependency) and your life slowly stops revolving around your next cigarette break!
Habitual Addiction, in my opinion, is often ignored and is the #1 reason why you have failed in the past. Smokers often say “I quit for 3 months but then I lost my job so I started smoking again”. This is because you did not address the habitual side. A dip or cigarette is a “comfort blanket” for when life throws you a curve ball and not planning for those urges down the road will lead to failure. This is where counseling comes in. Having someone help identify your triggers is essential. Fortunately this is a simple process. The Oregon Quit Line is one resource that you can tap into for free. People who access this option increase their chances of quitting by 18-20%. If you combine this with medication, your chances double!
You can go to www.quitnow.net or call 1-800 Quit Now for more information.
At Summit Spine, we know this is not easy. If you are reading this you most likely are in pain and considering surgery. We need for you to understand that surgery is only one small portion of your treatment plan and overall success. You need to take steps to optimize your physical and mental well-being before, during and after surgery. This means you need to obtain support from family and friends, eat healthy, exercise, actively participate in physical therapy and STOP SMOKING! If you need help please ask, we are here for you.
Sean Brown PA-C
Director of Patient Education & Clinical Research