Chris Gregg
General Manager, TBI Health, Wellington, NZ


Abstract
Does Smoking Impact Outcomes For Post-Operative Low Back Pain Patients Completing Rehabilitation?

Chris D Gregg*, Chris Hoffman**, Greg McIntosh***
* Physiotherapist, TBI Health, Wellington, NZ
** Spine Surgeon, TBI Health, Wellington, NZ
*** Epidemiologist, CBI Health Group Research Department, Toronto, Ontario

Introduction: Previous research has identified that smoking has a negative impact on the outcome of spine surgery¹.  The impact of smoking on post-operative spine patients completing active rehabilitation has not been fully determined. 

Aims: The purpose of this study was to compare clinical outcomes based on smoking status for a group of LBP patients (n=1017) completing rehabilitation following spine surgery.

Methods: This retrospective study of prospectively collected low back pain (LBP) cases was a collaborative effort of spine care rehabilitation clinics in New Zealand and Canada. Patient enrolment occurred between January 2008 and October 2012. 

Results: There were 395 cases from New Zealand and 622 from Canada. Of the total cohort, 518 (51%) were smokers.
At baseline, smokers had significantly higher levels of numeric pain rating, higher rate of general practitioner visits and lower perceived function (assessed by a modified version of the Low Back Outcome Score) (p<0.05) compared to non-smokers.

Adjusting for baseline differences, smokers had significantly less functional improvement after rehabilitation than the non-smokers (p<0.001).  Smokers had higher levels of pain following rehabilitation compared to non-smokers but achieved similar proportional improvements in pain following treatment.   Smokers and non-smokers achieved similar return to work rates after rehabilitation.

Discussion: Compared to non- smokers, LBP patients that smoke have higher pain, and lower levels of function, post-operatively. Post-operative LBP patients that smoke have poorer functional gains after rehabilitation and smoking cessation programmes could be an important adjunct for spine patients that require a high level of function post-operatively.  

References:
Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect of cigarette smoking and smoking cessation on spinal fusion.Spine (Phila Pa 1976). 2000 Oct 15;25(20):2608-15.