The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2
Macki M, Syeda S, Rajjoub K, Kerezoudis P, Bydon A, Wolinsky JP, Witham T, Sciubba DM, Bydon M, and Gokaslan Z. The effect of smoking status on successful arthrodesis after lumbar instrumentation supplemented with rhBMP-2. World Neurosurg 2017; 97:459-464.
OBJECTIVE: The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs.
METHODS: Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused.
RESULTS: Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48-15.24).
CONCLUSIONS: While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.
Medical Subject Headings
Bone Morphogenetic Protein 2; Combined Modality Therapy; Comorbidity; Female; Humans; Incidence; Intervertebral Disc Degeneration; Longitudinal Studies; Lumbar Vertebrae; Male; Middle Aged; Minnesota; Postoperative Complications; Recombinant Proteins; Retrospective Studies; Risk Factors; Smoking; Spinal Fusion; Transforming Growth Factor beta; Treatment Outcome