The Relationship Between Smoking and Your Back Pain

Smoking and Spinal Discs

How much smoking can you do before you get back pain, and what kind of back pain will you get?

Dr. Alexander Vaccaro, attending surgeon, orthopedics and neurosurgery, Thomas Jefferson University Hospital in Philadelphia, says that for people who smoke 50 packs a year or more, especially if they're under the age of 45, smoking is risky business.

For long term smokers, the AAOS reports an association between the number of pack-years (# of packs per day smoked X # of years as a smoker) and the development of herniated disc, as well as the progression of spondylolisthesis, an earlier onset of inflammation, and decreased functioning and quality of life.

While smoking likely works its “black magic” on many of the spinal structures, discs, in particular, take a heavy toll.

Smoking increases the rate at which discs degenerate, Vaccaro says. He adds that the chronic coughing experienced by many smokers can lead to increased pressure on discs, as well.

A 2009 review done by Kauppila called “Atherosclerosis and Disc degeneration/Low-Back Pain – A Systematic Review” found that obstructed arteries that branch off from the abdominal aorta can diminish blood flow to the lumbar spine and cause back pain. The review author comments that in those studies that looked at patterns of disease in populations (called epidemiological studies), smoking, along with high cholesterol, was most consistently associated with both low back pain and disc degeneration.

Smoking reduces exchange of substances you need for healthy discs, including oxygen, Vaccaro says. He explains: It constricts the arteries that go into the spinal vertebral arterial supply, which, in turn, can hinder the process of getting nutrition to the disc.

Smoking and Back Surgery

This photo contains content that some people may find graphic or disturbing.

See Photo

If you want a good result from your back surgery, particularly if it’s a spinal fusion, don’t smoke. 

In a spinal fusion, bone or bone-like material is placed between two ailing vertebrae as a way of stimulating them to unite. During the period following the surgery (about 3-4 months) the bones fuse, which doctors and researchers often call “healing.” This is a somewhat precarious time because a union of the vertebrae is not guaranteed. The Scoliosis Research Society says that at the very least between 5 and 15% of spinal fusions fail to heal.

And guess what tops the list of reasons for spinal fusion failure? Smoking.

In their article "Revision Strategies for Lumbar Pseudarthrosis" published on the Medscape website, Ondra and Marzouk report 33% more spinal fusion failure in smokers. In fact, some surgeons don’t even operate on smokers unless not doing so would jeopardize their life. Others counsel patients to quit smoking prior to surgery.

Post-Operative Complications

The AAOS says that smoking may be the single most important factor in postoperative complications, citing poorer outcomes and more frequent complications following spine surgery in smokers. This is true, they say, for any type of spine problem for which the surgery is done, including spinal stenosis, vertebral fractures or cervical spine decompression and fusion. Not only that, but the AAOS asserts patients’ tobacco use often predicts the occurrence of post-operative infections.

Smoking Cessation for a Healthier Back

While it’s pretty obvious that smoking contributes to back pain in a number of ways, including disc degeneration, it’s not a cause.

Genetics are probably the biggest cause of spinal degeneration, according to Truumees. Just the same, he says, low-back and neck arthritis are at least three times more common in smokers. Truumees, who is also Editor in Chief of AAOS Now, says that problems stemming from spinal degeneration include arthritis of the neck and back, herniated discs and bone spur formation (spinal stenosis).

Silver Lining in the Cloud

The good news is that the effects of smoking on the spine are in part reversible. That is, when you quit smoking, you may find you have less back pain, too. While the Finnish review noted more back pain in people who had successfully quit smoking than in those who had never smoked, former smokers had less back pain than current smokers.

The AAOS reports that reduced complications related to wound healing following spinal surgery in patients who preceded their procedure with a minimum of 4 weeks of smoking cessation.