It's no secret that smoking and using tobacco is terrible for you. Smoking is well documented to increase your risks for cancer, heart disease, stroke, lung diseases, and a lot of other health problems.

What you may not know is how bad smoking can be for your back. Smoking has not only been shown to increase your risk for developing spine problems, it also makes healing from back injuries and spine surgery that much more complicated.

How nicotine can lead to back pain and injuries

"What smoking does and why we hate it as doctors, is it really impairs blood flow to areas that already don't have great blood flow," explains Jared A. Crasto, M.D., with The Christ Hospital Physicians – Spine Surgery.

The main culprit is nicotine, the chemical in all tobacco products that make them so highly addictive. Nicotine constricts blood vessels and makes it harder for oxygen-rich blood and nutrients to reach tiny spaces within the spine so they can stay healthy and recover from everyday wear.

"Smokers in general have higher incidence of back pain," Dr. Crasto says. "They also have an advanced rate of osteoporosis and are more likely to suffer from degenerative disc disease or traumatic spine injuries than nonsmokers."

Chronic back pain carries with it additional risks for smokers and tobacco users looking for symptom relief. Dr. Crasto explains that it takes tobacco users longer to recover from back problems even if they are treated without surgery. That can lead to higher doses of prescription drugs to control pain.

"Smoking has a dose-dependent effect on opioid consumption," Dr. Crasto says. "If someone is in our office with back pain, chances are the more they smoke, the more opioids they're already on when they come to see us."

Why nicotine and tobacco are bad for spine surgery

When surgery is the best treatment option, tobacco users can expect a very frank conversation with their doctor about finally quitting. Having nicotine in your system before or after spine surgery generally leads to less optimal outcomes compared to non-smokers.

"The most important thing is that they stay nicotine free after surgery," Dr. Crasto says, pointing back to the constriction effect nicotine has on small blood vessels. "Wounds don't heal as fast. There's a higher risk wounds will open up and the surgery site may get infected."

And if that's not enough, Dr. Crasto warns that smokers face higher risks of the body rejecting the very procedures meant to make your spine better.

"If we're doing a fusion surgery, there's a higher risk of complications with the hardware – meaning screws could pull out or the rods may break," Dr. Crasto says. "And there's a lower rate that they achieve a fusion where the two bones fuse together."

When it's time to quit

Dr. Crasto recommends that patients stop smoking or using tobacco at least four weeks before surgery. But with tobacco coming in so many forms, the quit talk takes on added nuance.

"It's trickier now. We used to just have to ask people if they smoke," Dr. Crasto says. "Now we have to ask do you vape, do you use nicotine gum or patches."

Dr. Crasto says in some cases, smokers who switch to nicotine gum to curb their cravings may end up consuming more nicotine than when they were just smoking.

Fortunately, there are many free resources at The Christ Hospital to help you quit the nicotine habit for good. Your primary care provider or our lung nurse navigator will be more than happy to join your spine care team in supporting a tobacco-free lifestyle.

Your back will thank you, too!