Re: Smoking and Fusion

[Guest guest]

wrote:

> I've never heard of a surgeon who will attempt a

> long fusion on anyone

> who smokes.

>

I am surprised to hear this. Although they may

constitute a minority, I know for a fact that there

are outstanding and distinguished surgeons, members of

the Scoliosis Research Society, who do operate on

smokers. (Pre-1990s, of course, fusions on smokers

were routine.)

Let's face it: Research studies come and go. Although

smoking is horrendously damaging to the human organism

in innumerable ways, I won't be totally shocked if the

connection with less satisfactory spinal fusion turns

out to be illusory or evanescent. Anyone who regards

current research findings on this issue as conclusive

may want to review the past half-century of research

on, say, dietary cholesterol, caffeinated beverages,

use of the heart-lung machine for coronary artery

bypass graft, role of atherosclerosis in Prinzmetal's

angina, role of " bad parenting " in childhood autism or

adolescent schizophrenia, surgical approaches to

breast cancer, or post-menopausal estrogen

replacement.

Personally, I have had eight extensive spinal fusions,

including revision procedures for flatback syndrome. I

am currently fused from T-4 to S-1.

My first spinal fusion (no instrumentation) for

idiopathic scoliosis was performed when I was 13. Two

years later, at age 15, I unfortunately began to smoke

cigarettes (at the recommendation of an M.D.! -- but

that is a whole different story).

My second spinal fusion, with implantation of

instrumentation, was performed when I was in my late

thirties and had been a heavy smoker for many years.

Both times, my spine fused fine -- as it did during

the subsequent six operations as well. I have

experienced no pseudarthrosis either before or after I

quit smoking for good in 1987.

Most enlightened, empathic doctors realize how

terribly hard it is to quit. Forcing a person to

suffer ongoing deformity and pain because she can not

successfully go cold-turkey -- at a time when she is

under unusual stress to begin with, given her spinal

problems --seems unconscionable.

[Guest guest]

, only a former smoker could have written such a compassionate

letter! Good for you! I do not condone smoking, for sure. However, I am a

former smoker as well. What it took for me to be ABLE to quit was unbelievable

(and it was back in 1990). Quitting is not a joke or an easy task. Many

years ago, life at home was pretty awful, and even as a teenager, my nerves

were

beginning to be very frayed. My mother offered me opportunities to smoke

with her to " calm our nerves " . I have never blamed her for the habit. She

smoked until she was 89, by the way. Anyway, I always read compassion in your

posts.

Sincerely,

Carole

BTW, I love 's posts, as well. I love to see a good discussion between

the two of you!

[Guest guest]

...

I guess I've never discussed the issue with the surgeons to whom you

refer.

Many studies have shown that smokers have a 40-50% higher probability

of pseudarthrosis, so I'm guessing that many doctors typically deny

spinal fusion surgery to patients who are smokers if for no other

reason than to preserve their outcome statistics.

-- (an ex-smoker)

> I am surprised to hear this. Although they may

> constitute a minority, I know for a fact that there

> are outstanding and distinguished surgeons, members of

> the Scoliosis Research Society, who do operate on

> smokers. (Pre-1990s, of course, fusions on smokers

> were routine.)