Table 3.
A summary of the studies included in this review and their associated conclusions.
| Author(s) | Year of Publication | Type of spinal degeneration | Type of Study/Characteristics | Conclusion |
|---|---|---|---|---|
| Bagley et al. | 2019 | LSS | Comprehensive review of Lumbar spinal stenosis | Smoking is detrimental to recovery following surgery. (Bagley et al., 2019) |
| Sharma, M.K. and Petrukhina, E | 2013 | Lumbar DSD | Case-Control Study | Smoking is a strong risk factor for lumbar DSD, especially those with early onset lumbar DSD. (Sharma and Petrukhina, 2013) |
| Gore et al. | 2006 | Cervical DSD | Comparative roentgenographic study | There was no significant difference in the angle of cervical lordosis and degenerative spinal disease scores between smokers and non-smokers, suggesting no effect of smoking on the cervical spine. (Gore et al., 2006) |
| Jakoi et al. | 2017 | Lumbar Intervertebral DDD | Retrospective analysis of a nationwide private insurance database | Smoking had the greatest effect on lumbar spine degeneration compared to any other comorbidities. (Jakoi et al., 2017) |
| Joswig et al. | 2017 | Lumbar DDD | Two-center retrospective study | Smoking did not appear to have an effect on patient-reported outcome measures, measuring subjective functional impairment. (Joswig et al., 2017) |
| Bellitti et al. | 2021 | DDD | Review article | Smoking is a risk factor for DDD. (Bellitti et al., 2021) |
| Zhong et al. | 2021 | Cervical spondylotic myelopathy | Retrospective cohort study | Smoking was not found to be a risk factor for cervical spondylotic myelopathy. (Zhong et al., 2021) |
| Baucher et al. | 2021 | Degenerative cervical myelopathy | Review article | The mechanism by which smoking promotes spinal degeneration could be explained by the effects on nicotine on the vascular supply to the IVD, and also by activating the proinflammatory stress response, thus causing damage and leading to DDD. (Baucher et al., 2021) |
| Abbas et al. | 2013 | Degenerative LSS | Descriptive study of association between demographic factors, and physical characteristics with degenerative LSS | Smoking was not found to be associated with the diagnosis of degenerative LSS, even though it is a known predictor of the disease. (Abbas et al., 2013) |
| Ding et al. | 2021 | TSS | Retrospective study | Smoking was not found to be a risk factor for TSS. (Ding et al., 2021) |
| Kiraz, M. and Demir, E | 2020 | Lumbar DDD | Prospective study | Smoking was found to be a significant risk factor for Lumbar DDD, particularly in the L5-S1 spinal levels. (Kiraz and Demir, 2020) |
| Chen et al. | 2018 | Cervical DDD | Retrospective study | Smoking was found to exacerbate and accelerate cervical disc degeneration, causing more severe neck and shoulder pain in patients. (Chen et al., 2018) |
| Lambrechts et al. | 2021 | Cervical DDD | Retrospective study | Smoking caused increased cervical spinal disc degeneration. (Lambrechts et al., 2021) |
| Elmasry et al. | 2015 | IVD degeneration | A finite element study | Smoking tended to affect the AF more than NP in lighter smokers, although for heavy smokers, it caused decreased GAG levels in both the NP and the AF, causing degeneration of the discs. (Elmasry et al., 2015) |
| Battié et al. | 1991 | Lumbar Intervertebral DDD | Twin Cohort Study | Smoking was found to have a strong impact on the lumbar discs in this study particularly, as it was compared between twins who were genetically identical. (BATTIÉ et al., 1991) |
| Doğan et al. | 2019 | Lumbar DDD | Retrospective study | Cigarette smoking can lead to lumbar intervertebral DDD. (Doğan et al., 2019) |
| Han et al. | 2017 | Lumbar Intervertebral DDD | Retrospective study | Smoking did not appear to cause Modic changes in the lumbar discs of patients. (Han et al., 2017) |
| Huang et al. | 2015 | LDH | Systematic review | Smoking appeared to promote the occurrence of LDH. (Huang et al., 2015) |
| Altun, I. and Yuksel, Kz. | 2017 | IVD degeneration | Experimental study | Maternal smoking before and during pregnancy and before lactation caused increased fibrosis and decreased proteoglycans, leading to increased degeneration in the spine of the new-borns. (Altun and Yuksel, 2017) |
| Wang et al. | 2012 | IVD degeneration | Experimental study | Tobacco smoking affects the proteoglycan content in the discs as well the process of replenishing them and collagen. Thus, smoking causes degeneration of the spinal discs. (Wang et al., 2012) |
| Kwon et al. | 2020 | Spinal DDD | Retrospective cohort study | Smoking affects the spine in patients and leads to degeneration and increased lower back pain compared to non-smokers. (Kwon et al., 2020) |
| Saberi et al. | 2009 | Lumbar spinal disease | Prospective cross-sectional study | Smoking leads to NP dislodgement and subsequent spinal degeneration. (Saberi et al., 2009) |
| Nakahashi et al. | 2019 | IVD degeneration | Experimental study | Passive smoking directly affects both the NP and CEP of IVDs, sparing AF. However, the mechanism of action differs in that the architecture and characteristics of NP are damaged by smoking, whereas apoptosis is induced in CEP. (Nakahashi et al., 2019) |
| Numaguchi et al. | 2015 | IVD degeneration | Experimental study | Smoking was found to disrupt normal molecular mechanisms by disrupting genes that contributed to the maintenance of the circadian rhythm. As a result, alterations to molecular mechanisms led to the destruction of the IVD. (Numaguchi et al., 2015) |
| MacDowall et al. | 2017 | Cervical DDD | Post hoc analysis of a Randomised controlled trial | Smoking did not play a role in non-neurogenic neck pain in people with cervical DDD. (MacDowall et al., 2017) |
| Khurana, VG | 2021 | Spondylosis | Literature Review | Smoking not only caused degeneration of the spine and spondylosis, but also postoperative complications and impairment in wound healing. (Khurana, 2021) |
| Jacobsen et al. | 2007 | Degenerative lumbar spondylolisthesis | Cross-sectional epidemiological study | Smoking did not play a role in degenerative lumbar spondylolisthesis. (Jacobsen et al., 2007) |
| Schumann et al. | 2010 | Lumbar DDD | Multi-center Case-Control Study | The correlation between smoking and LDH was unclear, and according to the study, did not have a clear dose-response relationship. (Schumann et al., 2010) |
| Yang et al. | 2019 | LDH | Case-Control Study | Smoking was found to have a greater effect in individuals with certain genes that made them more susceptible to the effects of the chemical components of cigarettes. Certain polymorphisms were also found to be more protective against smoking than others. There was an interesting correlation between smoking and genetic susceptibilities. (Yang et al., 2019) |
| Snyder et al. | 2010 | Degenerative spondylolisthesis and spinal stenosis | Cohort study | Spondylolisthesis treatment was not affected by smoking and there were no post-treatment complications. Spinal stenosis surgery can be complicated by smoking including infection and other post-surgical complications. (Snyder et al., 2022) |
| Sheung-tung, H. | 2017 | Lumbar disc prolapse, LSS, Cervical myelopathy | Review article | Smoking was responsible for a variety of possible complications following surgery including poor wound healing and greater mortality. Surgery was often indicated in smokers, and they carried a greater risk of developing surgical site infections. (Sheung-tung, 2017) |
| Sandén et al. | 2011 | LSS | Cohort study | Poor outcomes and satisfaction post-surgery for LSS was observed in patients who smoked compared to those who did not. (Sandén et al., 2011) |
| Liu et al. | 2021 | Cervical laminoplasty for cervical myelopathy | Retrospective Review | Smoking caused a decrease in the range of motion and higher reoperation rates of the cervical spine following cervical laminoplasty. (Liu et al., 2021) |
| An et al. | 1994 | Lumbar and Cervical DDD | Retrospective Study | Smoking significantly increased the risk of developing lumbar disc prolapse and cervical disc degeneration in both males and females. (An et al., 1994) |
| Burkhardt et al. | 2020 | Cervical fusion and Lumbar DDD | Cohort study | Smoking did not play a role in indicating surgery for lumbar DDD and anterior cervical fusion. (Burkhardt et al., 2020) |
| Tu et al. | 2019 | Cervical disc arthroplasty for cervical disc herniation or spondylosis | Retrospective Review | Cervical disc arthroplasty may be a good option for smokers as it had a more improved outcome than non-smokers. (Tu et al., 2019) |
| Konovalov et al. | 2021 | Lumbar total disc arthroplasty for DDD | Observational study | Smoking increased post-surgical complication of heterotopic ossification in the spine, but did not affect mortality. (Konovalov et al., 2021) |
| Smith et al. | 2014 | Lumbar DDD | Retrospective Review | Smoking affected the recovery of patients post-surgery, with decreased satisfaction and increased pain. (Smith et al., 2014) |
| Nunley et al. | 2013 | Cervical DDD | Randomised Controlled Trial | Smoking did not play a role in causing the complication of developing adjacent segment disease following total disc replacement in the cervical spine. (Nunley et al., 2013) |
| Tetreault et al. | 2016 | Degenerative cervical myelopathy | Systematic Review | Smoking did not play a role in complications post laminectomy or laminoplasty for degenerative cervical myelopathy. (Tetreault et al., 2016) |
| Stienen et al. | 2016 | Lumbar spine surgeries for LDH or LSS | Prospective observational study | Smoking does not impact the response of a patient to surgery but does delay healing, potentially causing the need to undergo surgery again. (Stienen et al., 2016) |
| Wang et al. | 2021 | Cervical DDD | Retrospective single-center cohort study | Smoking causes poorer outcomes following hybrid surgery for multilevel cervical disc disease, including poor fusion and increased bone loss. (Wang et al., 2021) |
| Behrend et al. | 2012 | IVD disease | Prospective study | There is a strong association between smoking and pain in people undergoing surgery, which can be improved with smoking cessation. (Behrend et al., 2012) |
| Asher et al. | 2017 | Lumbar DSD | Retrospective analysis of prospectively collected data | Smokers were more likely to undergo surgery or decompression for their spinal disease and reported greater pain at baseline and following surgery than non-smokers. (Asher et al., 2017) |
| Bydon et al. | 2015 | Laminectomy for Lumbar spondylosis | Retrospective Review | Smoking was found to be a strong predictor of reoperation after surgeries for lumbar spondylosis. (Bydon et al., 2015) |
| Nakhla et al. | 2018 | Spondylolisthesis | Retrospective Review | Smoking appears to cause wound complications only following certain surgeries and not others, suggesting that certain surgeries may be a better option for smokers. Smoking however, still was a predictor of infection regardless of which fusion option was chosen. (Nakhla et al., 2018) |
| Patel et al. | 2020 | Lumbar Spondylolisthesis | Prospective Study | There appeared to not be a great difference in response to the surgery for grade 1 lumbar spondylolisthesis between smokers and non-smokers, although smoking appears to decrease the chances of achieving minimum clinically important difference in ODI since smokers have a low baseline ODI to begin with. (Patel et al., 2020) |
| Goyal et al. | 2020 | Lumbar decompression for spinal stenosis/disc herniations | Retrospective cohort study | Smoking status was not a predictor of outcome following lumbar decompression. (Goyal et al., 2020) |
| Ngo et al. | 2017 | IVD degeneration | Experimental study | Disc degeneration due to smoking is increased by activating ADAMTS5, which causes pathological release of aggrecan and also induced inflammatory pathways, causing further disc damage. (Ngo et al., 2017) |
| Jing et al. | 2020 | IVD degeneration | Experimental study | Smoking appears to cause the activation of apoptosis of AF through the mitochondrial pathway, induced by cadmium accumulation in the body. (Jing et al., 2020) |
| Cong et al. | 2010 | IVD degeneration | Experimental study | Smoking tended to impact certain alleles more than the other and to different extents, suggesting yet again a relationship between susceptible genes and smoking on DDD. (Cong et al., 2010) |
| Lo et al. | 2021 | IVD degeneration | Experimental study | Nicotine causes the degeneration of the IVDs by impacting the IGF-1 pathway, which causes chondrocyte reduction as well as a decrease in chondrogenic indicator levels. (Lo et al., 2021) |
| Luo et al. | 2020 | LDH | Case-Control Study | Another study showing the impact of smoking on people who already have genes susceptible to developing LDH, showcasing a clear increase in the trend. (Luo et al., 2020) |
| Gulati et al. | 2015 | LSS | Multi-center Observational registry-based study | Smokers with LSS had decreased improvement at 1 year following microcompression, greater pain and decreased number of smokers were able to reach the minimal clinically important difference for spinal degeneration. (Gulati et al., 2015) |
| Hadley, M and Reddy, S | 1997 | DSD | Review article | Smokers tend to cause both preoperative and post-operative issues, including poorer outcomes and bony degradation. (Hadley and Reddy, 1997) |
| Connor et al. | 2020 | DSD | Retrospective Database Study | Smoking causes a greater risk of readmission 90 days post-surgery, which might be a factor to consider prior to electing for surgery in these patients. (Connor et al., 2020) |
| Grisdela et al. | 2017 | Cervical DDD | Retrospective analysis | Tobacco use increased the chances of undergoing surgery, in both patients with or without myelopathy and disc disease. Hence, smoking is an independent predictor of surgery. (Grisdela et al., 2017) |
| Nasto et al. | 2014 | IVD degeneration | Experimental study | Spinal disc degeneration was highly impacted by smoking, where the main factors responsible for the maintenance of the discs were destroyed. (Nasto et al., 2014) |
| Holm, S and Nachemson A | 1988 | IVD degeneration | Experimental study | Smoking caused impairment of nutritional supply and oxygen supply to the discs, leading to impaired aerobic respiration, a consequent build-up of lactate, and degeneration of the disc. (Holm and Nachemson, 1988) |
| Fogelholm, R. R and Alho, A. V | 2001 | IVD degeneration | Review article/Medical hypotheses | Smoking contributes to the degeneration of the spinal disc, which is responsible for causing debilitating lower back pain. The authors further hypothesise that “high serum proteolytic activity of cigarette smokers gets access to a previously degenerated neovascularized disc and speeds up the degenerative process”. (Fogelholm and Alho, 2001) |