There are thousands of reasons to quit smoking: 480,000, at least. That’s how many people cigarette smoking kills in the United States each year, according to the Centers for Disease Control and Prevention (CDC). Need any more reasons to quit? How about this: Before smoking does you in it sentences you to a life of misery. Smoking can cause or greatly increase the risk of many cancers, heart disease and even back pain due to the link between smoking and degenerative disc disease.
What Is Degenerative Disc Disease?
Fibrocartilage discs sit between each of the spine’s vertebrae, acting as shock absorbers. Over time, these discs start to break down, becoming weaker, less pliable and less effective. This breakdown is known as degenerative disc disease, and it puts discs at risk of herniating, where the soft, jellylike inner layer (the nucleus puposa) punches through the hard outer layer (the annulus).
The protruding portions of the inner layer have the tendency to press on the nerve roots that originate in the spinal column, which can cause pain, tingling, numbness and, in advanced cases, even muscle atrophy. The lower back (lumbar spine) and neck (cervical spine) are at greater risk of degenerative disc disease than the mid-back (thoracic spine), and are affected by degenerative disc disease more often.
Smoking and Degenerative Disc Disease
Smoking and back pain are known to be linked. Smoking’s association with this specific form of back pain—degenerative disc disease—is one of the strongest.
Nicotine damages cells in the intervertebral discs in a number of ways. First, it deprives the cells in the discs of nutrients they need to stay strong and healthy. This results in weaker discs. Nicotine also slows down the rate at which cells in the discs regenerate.
The use of nicotine can also lead to early disc desiccation, or loss of fluid. Slowly and over time, the fluid in the intervertebral discs leaks out and is replaced by fibrocartilage, the tough tissue that makes up the annulus. Desiccated discs are stiffer and less pliable than healthy discs.
Additionally, nicotine is a vasoconstrictor—that is, it causes blood vessels to contract. That’s one of the reasons nicotine is so dangerous for the heart—because vasoconstriction causes high blood pressure—but it also affects cellular healing and repair in the intervertebral discs. Vasoconstriction inhibits blood flow, and blood flow is necessary for cells to repair themselves. Less blood flow to and around the intervertebral discs means the discs of smokers can’t repair themselves as efficiently as nonsmokers.
Finally, smoking causes the hallmark “smoker’s cough.” Every cough puts extra pressure on the intervertebral discs, which further contributes to their wear-and-tear.
Smoking and Surgery for Back Conditions
Not only is it extremely likely that smoking contributes directly to back pain, it also makes treating back pain more difficult. In general, smokers have greater rates of complications from surgery than nonsmokers.
Specifically, smokers have a higher chance than nonsmokers of developing blood clots in the legs after surgery, a condition known as deep vein thrombosis. These clots can break off from artery walls and travel up to the lungs, causing a pulmonary embolism that blocks blood flow and causes lung tissue to die.
And, since nicotine deprives cells of oxygen, the surgical wounds of smokers may be more likely to heal slower or get infected. Danish researchers analyzed 13 studies, containing data from about 2,000 people who had surgery of all sorts, from arthroplasty to chest and heart surgery. Their analysis found that about 9 percent of people who quit smoking four weeks before surgery had complications, while 28 percent of those who did not quit before surgery experienced complications.
More specifically, smoking inhibits healing from and increases the risk of complications of certain back surgeries. A 2012 study in the journal Spine suggested that surgery was the best treatment option for anyone with spinal stenosis, a potentially painful narrowing of the spinal canal—except smokers.
Further, fusion surgery—a mainstay of treatment for degenerative disc disease—is less successful and more prone to complications in smokers, according to a 2017 review of studies published in International Journal of Spine Surgery. Smokers in the study had greater rates of nonunion in lumbar spinal fusions, the analysis suggests. One study included in the review found that smokers had a more-than-double rate of infections than nonsmokers after orthopedic procedures. Another suggests smokers are nearly twice as likely as nonsmokers to need a second operation after cervical fusion.
Kicking the Habit
As physicians, every one of my colleagues and I are delighted every time one of our patients (or anyone else) decides to quit smoking. Many people report quitting smoking is the most difficult thing they’ve ever done. Here are some resources to hopefully make the process easier:
- American Heart Association resources
- American Lung Association resources
- gov, a program of the National Cancer Institute
- The CDC on how to quit
If you are experiencing degenerative disc disease, schedule an appointment with me. I’ll be happy to develop a treatment plan that’s right for you and your situation.