Impact of smoking on complication and pseudarthrosis rates after single- and 2-level posterolateral fusion of the lumbar spine

Mohamad Bydon, Rafael De La Garza-Ramos, Nicholas B. Abt, Ziya L. Gokaslan, Jean Paul Wolinsky, Daniel M. Sciubba, Ali Bydon, Timothy F. Witham

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


STUDY DESIGN.: Retrospective study. OBJECTIVE.: To study the impact of smoking status on postoperative complications and pseudarthrosis in adult patients undergoing posterolateral fusion (PLF) of the lumbar spine. SUMMARY OF BACKGROUND DATA.: Results of studies analyzing the impact of smoking on complication and pseudarthrosis rates after spine surgery are conflicting. METHODS.: A retrospective medical record review was performed to identify all adult patients who underwent single- and 2-level instrumented PLF without interbody devices for degenerative spine disease in a 21-year period at a single institution. Patients were divided into smokers and nonsmokers. The main outcome variables were development of at least one postoperative complication and development of pseudarthrosis. RESULTS.: A total of 281 patients underwent single- or 2-level PLF in the 21-year period. Of these, 231 (82.21%) patients were nonsmokers and 50 (17.9%) were smokers. For patients undergoing single-level PLF, complication rates in nonsmokers (3.57%) versus smokers (7.69%) were not significantly different (P = 0.353); pseudarthrosis in nonsmokers occurred in 9.82% of cases compared with 7.69% in the smokers group (P = 0.738). Nonsmokers undergoing 2-level PLF had complication rates of 6.72%, compared with 4.17% in smokers (P = 0.638), but pseudarthrosis rates were significantly higher in the smokers group than in the nonsmokers group (29.17% vs. 10.92%; P = 0.019). Patients were followed up for an average of 53.5 months. CONCLUSION.: The findings in this study suggest that smoking has a significant impact on pseudarthrosis rates after 2-level PLF of the lumbar spine, but not necessarily on single-level PLF.Level of Evidence: 4.

Original languageEnglish (US)
Pages (from-to)1765-1770
Number of pages6
Issue number21
StatePublished - Oct 1 2014


  • complications
  • fusion
  • lumbar
  • outcomes
  • posterolateral fusion
  • pseudarthrosis
  • smoking
  • spine
  • surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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