Smoking Does Not Negatively Impact Outcomes Following Cervical Laminoplasty: A Quality Outcomes Database Study

Brian Q Hou; Andrew Croft; Hani Chanbour; Omar Zakieh; Hui Nian; Jacquelyn S Pennings; Mitchell Bowers; Mason W Young; William H Waddell; Amir M Abtahi; Raymond J Gardocki; Julian G Lugo-Pico; Scott L Zuckerman; Byron F Stephens

doi:10.1097/BSD.0000000000001732

Smoking Does Not Negatively Impact Outcomes Following Cervical Laminoplasty: A Quality Outcomes Database Study

Clin Spine Surg. 2024 Nov 21. doi: 10.1097/BSD.0000000000001732. Online ahead of print.

Authors

Brian Q Hou^{1

2}, Andrew Croft¹, Hani Chanbour¹, Omar Zakieh¹, Hui Nian³, Jacquelyn S Pennings^{2

3

4}, Mitchell Bowers⁴, Mason W Young⁴, William H Waddell⁴, Amir M Abtahi^{1

4}, Raymond J Gardocki^{1

4}, Julian G Lugo-Pico^{1

4}, Scott L Zuckerman^{1

5}, Byron F Stephens^{1

4}

Affiliations

¹ Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN.
² Vanderbilt University School of Medicine.
³ Center for Musculoskeletal Research, Vanderbilt University Medical Center.
⁴ Departments of Orthopedic Surgery.
⁵ Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.

PMID: 39569879
DOI: 10.1097/BSD.0000000000001732

Abstract

Study design: Retrospective cohort study.

Objective: To assess the impact of smoking on outcomes following elective cervical laminoplasty for degenerative cervical myelopathy (DCM).

Summary of background data: The detrimental effect of cigarette smoking on cervical spinal fusion surgery outcomes is well documented. However, the impact of smoking on outcomes following nonfusion cervical spine procedures is unknown. One commonly utilized nonfusion technique for cervical decompression is laminoplasty.

Methods: Adult smokers or nonsmokers who underwent primary elective laminoplasty for DCM were included. The propensity score (PS) was constructed for being a current smoker based on covariates. Only patients contained in the PS overlapped region were included in the analysis set. Patient-reported outcomes (PROs) at baseline and 12 months postoperation included Visual Analog Scale (VAS) neck and arm pain, neck disability index (NDI)%, EuroQol-5 Dimension (EQ-5D), and modified Japanese Orthopedic Association (mJOA) scores. Other outcomes included perioperative complications, 3-month readmissions/reoperations, and patient satisfaction. Wilcoxon and Pearson tests were used to compare outcomes between smokers and nonsmokers.

Results: The study included 132 patients: 30 were smokers (22.7%) and 102 were nonsmokers (77.3%). No significant differences were found at baseline between groups in demographics or medical history. Smokers had significantly worse baseline VAS neck pain (5.7±3.2 vs. 4.4±3.04, P=0.028) and arm pain (5.7±3.5 vs. 4.3±3.2, P=0.045) scores, but all other baseline PROs were not statistically different between groups. No differences were found between smokers and nonsmokers in any 12-month PRO, or in rates of perioperative complications, 3-month readmissions, or 3-month reoperations. On multivariable logistic regression analysis, smoking had no significant impact on any outcome of interest.

Conclusion: Clinical and PROs following elective laminoplasty for DCM are not significantly different between smokers and nonsmokers. Laminoplasty should be considered a good surgical option in smokers presenting with DCM.