As the global population ages, cervical disc degeneration and myelopathy in the neck of the spine are growing health concerns. While age is a well-known risk factor for degenerative disc disease, new research identified a potential link between smoking (tobacco use disorder), cervical degenerative disc disease and myelopathy.
What is degenerative disc disease? It’s not really a disease—rather it often starts when age-related or wear and tear injuries alter the structural integrity and strength of one or more intervertebral discs. Discs in the neck or back may bulge, herniate, narrow or flatten and contribute to development of disorders that compress spinal nerve roots and/or the spinal cord. Pain is the hallmark symptom.
When the spinal cord is compressed, the condition is called myelopathy. Some symptoms are attributable to spondylosis, also called spinal osteoarthritis that is arthritis of the spine. Cervical myelopathy is known to cause neurological problems that may affect balance and walking.
Myelopathy from cervical degenerative disc disease can occur when the inner, gel-like portion of the disc seeps out from a degenerated disc, which puts pressure on the nearby vertebral body. This can cause osteophytes (bone spurs) to grow, and that can compress the spinal cord. When myelopathy occurs, you may experience nerve-related symptoms like numbness, tingling, weakness, and radiating pain.
While degenerative disc disease in your neck alone may be managed with non-surgical treatments, myelopathy requires surgical intervention to relieve spinal cord and nerve compression that may lead to severe symptoms (eg, balance problems, difficulty walking). Decompression surgeries, such as anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), and anterior cervical corpectomy and fusion (ACCF) are common procedures performed to free up space around the spinal cord.
Closer Look at the Study and Research Findings
Research published in the May 2017 issue of the European Spine Journal looked at patients who had cervical disc degeneration with or without myelopathy between 2007 and 2013.
Using an insurance database to identify the patients, the research team discovered that patients who had been diagnosed with tobacco use disorder (eg, smoking) had spine surgery more often than patients who did not smoke. In fact, smokers were more than twice as likely to undergo cervical spine surgery as non-smokers.
And, it wasn’t just that smokers were having neck surgery more often—they were having the procedure at a younger age. The peak age group for non-smoking patients who underwent surgery was between 60 and 79 years, while the peak age of surgery for smokers was between 40 and 59 years.
“A younger age of onset could result in more lost work time as well as a greater lifetime risk of complications from surgery or the need for revision surgery,” the authors wrote.
The research team also examined whether the smoking patients stopped smoking between the time they were diagnosed with cervical degenerative disc disease and the time of their surgery. Evidence showed that those who smoked at the time of surgery had a higher risk of complications and infections after surgery—in addition to poorer outcomes. So patients are recommended to quit smoking at least 4 weeks prior to surgery.
Despite this, the researchers found that the majority of patients who smoked (76.3% who had myelopathy and 68.9% who only had cervical degenerative disc disease) did not quit smoking before surgery.
“This could indicate the need for either more aggressive smoking cessation aid or more restrictive patient selection,” the authors wrote.
How Tobacco Wreaks Havoc on Your Spine
Cigarette smoking is among the top preventable causes of medical problems and death. Tobacco inhibits bone growth and bone health—and certainly includes your spinal bones (vertebrae). Nicotine also reduces your body’s circulation of blood, making it harder for oxygen and key nutrients to move throughout your body.
If you smoke cigarettes (eg, use tobacco) and are exploring the prospect of spine surgery, talk to your spine surgeon about the potential risks you face if you do not quit. He or she may also be able to connect you to resources that can support you if you decide to quit smoking.
You can learn more about how smoking affects your spine—and your ability to successfully recover from surgery—in Cigarette Smoking and Its Impact on Spinal Fusions and Smoking, Tobacco Use, e-Cigarettes and Spine Surgery.