ArticleBMC musculoskeletal disorders2021
The impact of smoking on outcomes following anterior cervical fusion-nonfusion hybrid surgery: a retrospective single-center cohort study.
Article in BMC musculoskeletal disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- The association between smoking and clinical outcomes among spondylodesis patients: A systematic review and meta-analysis.PloS one · 2026Pooled it
- Pooled it
- Adverse Impact of Smoking on Spine Fusion and Patient-Reported Outcomes: A Systematic Review and Meta-Analysis.Global spine journal · 2026Review
- Smoking significantly impairs clinical outcome following anterior cervical radiculopathy surgery.Brain & spine · 2026Article
- Complications associated with anterior cervical spine surgery: A systematic review of literature.Brain & spine · 2026Review
- The effect of smoking on the radiological and functional outcomes of anterior cervical discectomy and fusion with anchored standalone cages.Journal of spine surgery (Hong Kong) · 2025Article
- Article
- Impact of nicotine product use on outcomes of patients receiving cervical disc arthroplasty: a propensity score analysis of the united States nationwide inpatient sample 2005-2020.Journal of orthopaedic surgery and research · 2025Article
- Impact of surgical risk factors for non-union on lumbar spinal fusion outcomes using cellular bone allograft at 24-months follow-up.BMC musculoskeletal disorders · 2024Article
- Pulsed Electromagnetic Fields for Cervical Spine Fusion in Patients with Risk Factors for Pseudarthrosis.Orthopedic reviews · 2024Article
- Pulsed Electromagnetic Field Stimulation in Lumbar Spine Fusion for Patients With Risk Factors for Pseudarthrosis.International journal of spine surgery · 2023Article
- Cervical sagittal balance after consecutive three-level hybrid surgery versus anterior cervical discectomy and fusion: radiological results from a single-center experience.Journal of orthopaedic surgery and research · 2023Article
- Sex and gender determinants following spinal fusion surgery: A systematic review of clinical data.Frontiers in surgery · 2022Review
- Smoking and degenerative spinal disease: A systematic review.Brain & spine · 2022Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is mixed evidence for the impact of cigarette smoking on outcomes following anterior cervical surgery. It has been reported to have a negative impact on healing after multilevel anterior cervical discectomy and fusion, however, segmental mobility has been suggested to be superior in smokers who underwent one- or two-level cervical disc replacement. Hybrid surgery, including anterior cervical discectomy and fusion and cervical disc replacement, has emerged as an alternative procedure for multilevel cervical degenerative disc disease. This study aimed to examine the impact of smoking on intermediate-term outcomes following hybrid surgery.
methodsRadiographical and clinical outcomes of 153 patients who had undergone continuous two- or three-level hybrid surgery were followed-up to a minimum of 2-years post-operatively. The early fusion effect, 1-year fusion rate, the incidence of bone loss and heterotopic ossification, as well as the clinical outcomes were compared across three smoking status groups: (1) current smokers; (2) former smokers; (3) nonsmokers.
resultsClinical outcomes were comparable among the three groups. However, the current smoking group had a poorer early fusion effect and 1-year fusion rate (P < 0.001 and P < 0.035 respectively). Both gender and smoking status were considered as key factors for 1-year fusion rate. Upon multivariable analysis, male gender (OR = 6.664, 95% CI: 1.248-35.581, P = 0.026) and current smoking status (OR = 0.009, 95% CI: 0.020-0.411, P = 0.002) were significantly associated with 1-year fusion rate. A subgroup analysis demonstrated statistically significant differences in both early fusion process (P < 0.001) and the 1-year fusion rate (P = 0.006) across the three smoking status groups in female patients. Finally, non-smoking status appeared to be protective against bone loss (OR = 0.427, 95% CI: 0.192-0.947, P = 0.036), with these patients likely to have at least one grade lower bone loss than current smokers.
conclusionsSmoking is associated with poor outcomes following hybrid surgery for multilevel cervical disc disease. Current smokers had the poorest fusion rate and most bone loss, but no statistically significant differences were seen in clinical outcomes across the three groups.
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