Comparison of Smoking Habits Between Patients with Surgically Confirmed Herniated Lumbar and Cervical Disc Disease and Controls

Summary 

There have been numerous studies that implicate cigarette smoking as a risk factor for the development of back pain or disc disease. The purpose of this article is to review patients who underwent surgery for cervical or lumbar radiculopathy and to investigate the relationship between cigarette smoking and development of surgical disc disease. A cigarette smoking study of 205 surgical patients with lumbar and cervical disc diseases was done, with the surgical patients compared to 205 age-sex-matched inpatient controls during 1987–1988. This study was conducted at the Pennsylvania Hospital in Philadelphia, Pennsylvania. There were 163 patients with lumbar disc disease and 42 patients with cervical disc disease. The ratio of men to women was 1.5:1 for lumbar disc and 2.5:1 for cervical disc disease. Smoking history (current and ex-smokers) was strikingly increased in both prolapsed lumbar intervertebral disc (56% vs. 37% of controls, p = 0.00029) and cervical disc disease (64.3% vs. 37% of controls, p = 0.0025). Calculated relative risks for smokers were 2.2 for lumbar disc and 2.9 for cervical disc diseases. This association between cigarette smoking and disc disease was more significant when comparing between current smokers versus nonsmokers (p = 0.000011 for lumbar disc disease, and p = 0.00064 for cervical disc disease). Relative risks for current smokers were 3.0 for lumbar disc and 3.9 for cervical disc diseases. This correlation was significant for both males (p = 0.000068 for lumbar disc disease, p = 0.043 for cervical disc disease) and females (p = 0.018 for lumbar disc disease, p = 0.006 for cervical disc disease). There were no statistically significant differences between ex-smokers versus nonsmokers. Only 10 of 26 ex-smokers quit smoking within 5 years in the disc disease group, and 16 of 38 ex-smokers in the control group quit smoking in the last 5 years of admission. This study confirms previous reports on the association between disc disease and cigarette smoking. This study is different from previous reports in that surgically confirmed patients were studied in this investigation. All patients had severe discogenic and radicular symptoms to require surgery. The following speculations can be made from this study: (a) The association between cigarette smoking and intervertebral disc disease is more significant in the surgical group than the non-surgical group as previously reported, (b) Continued cigarette smoking may aggravate discogenic or radicular symptoms in patients with intervertebral disc disease, (c) Stopping cigarette smoking may have beneficial effects as no significant differences were found between ex-smokers versus nonsmokers.