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SAN FRANCISCO, Mar 05 (Reuters Health) - While smoking is a well-known risk factor for heart disease and cancer, the habit can also wreak havoc on bones and muscles. Smokers not only face a higher risk of problems such as bone loss and back pain, but they may also fare poorly after certain surgical procedures, researchers report.
Study findings presented here last week at the annual meeting of the American Academy of Orthopedic Surgeons highlighted some less-recognized health impacts of smoking.
In one report, investigators from Johns Hopkins University in Baltimore, Maryland, linked smoking to chronic low back pain. According to the researchers, their 50-year study of more than 1,300 people provides some of the best evidence to date that smoking can impede the blood supply to the lower spine, resulting in back pain and degenerative disk disease.
But besides doing the damage in the first place, smoking can also get in the way when surgeons try to repair bone, according to a research team from the University of Toronto, Canada. In a study of 110 patients, the surgeons found that smokers did significantly worse than nonsmokers after a procedure used to repair bone breaks and, less often, congenital defects.
The surgery, called Ilizarov reconstruction, is a complicated procedure used for fractures that are healing poorly, most commonly in the shinbone. When it fails, the limb may have to be amputated. And, Dr. Michael D. McKee said, smokers are more likely to see the surgery fail. Of the five amputations in his team's study, all were performed on smokers.
In addition, McKee and his colleagues found that 30% of smokers had "poor results" such as failed bone healing and persistent infection, compared with 8% of nonsmokers. With these findings in mind, the surgeons have set rules for offering Ilizarov reconstruction to smokers.
"We won't flat-out refuse to do it," McKee said. "But we ask them to stop smoking."
Because the surgery requires patients to wear a frame that is attached to the healing bone for several months, McKee said smokers must quit for a "6-month window," beginning several weeks before the procedure.
This short-term abstinence has seemed to work, according to the Toronto researchers. Smoking, McKee explained, likely hinders the success of the surgery because it impairs blood flow to the healing bone. Because the nicotine in cigarettes triggers immediate constriction in blood vessels, quitting even shortly before the surgery improves patients' blood flow, according to McKee.
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