Smoking affects the body from head to toe, infamously raising the risk of serious problems like cancer and heart disease. But there is another, less commonly known risk of tobacco use: increased back pain and damage to the spine.
“There is evidence that smokers fare worse than non-smokers when it comes to back pain, and smokers can also face more risks from spine surgery,” says Chad F. Claus, D.O., a neurosurgeon at Henry Ford Health.
Dr. Claus shares the latest science on the link between nicotine and spine health, and how tobacco users can reduce the risk of back pain and complications.
Nicotine and Spine Health
Nicotine, the active ingredient in tobacco, has a host of harmful effects on the body. “As far as spine health is concerned, the biggest issue with nicotine comes down to blood supply,” Dr. Claus explains.
Nicotine causes vasoconstriction, or narrowing of the blood vessels, which reduces the amount of oxygen-rich blood flowing to the body’s tissues. Nicotine also increases inflammation, which damages the body’s tissues.
The spine is made up of bony vertebrae with protective, gel-like discs of cartilage in between. Unfortunately, the vertebrae and discs don’t have a strong blood supply of their own. By reducing blood flow even more, nicotine use can speed up wear and tear and increase the risk of common spine problems:
- Spinal osteoarthritis: Breakdown of the cartilage in the joints of the spinal column
- Degenerative disc disease: The breakdown of the cushiony discs between the vertebrae
Both conditions can cause pain in the neck or lower back that can be severe.
The Risks of Nicotine
Research shows that smoking can significantly increase the risk of back pain. In fact, one Swedish study that followed more than 300,000 construction workers over time found that heavy smokers were 46% more likely to need surgery for their back pain than non-smokers.
But cigarettes aren’t the only culprit. “These risks aren’t unique to smoking tobacco,” Dr. Claus notes. “Other types of nicotine products, including vaping, nicotine pouches or chewing tobacco, can also cause vasoconstriction and lead to spine damage and back pain.”
Spine Care at Henry Ford
And nicotine harms the body in other ways that can affect spine health. People who smoke are more likely to have obesity and to get less exercise, for example. Those factors can also increase the risk of back pain.
Smoking and Surgery
Smoking and nicotine use can also interfere with the body’s ability to heal and handle the stress of surgery. That is an important factor for people considering back surgery to treat their back or neck pain, Dr. Claus says.
“On average, non-smokers have better surgical outcomes than smokers do. They tend to respond better to anesthesia and have fewer surgical complications, including heart and lung complications,” he says.
They also heal better from the operation. “Healing well depends on a good blood supply so that tissues get plenty of oxygen and nutrients as they recover,” he adds. One common surgery for back pain is spinal fusion. This procedure fuses two vertebrae together to limit painful motion and improve stability of the spine.
But a successful spinal fusion requires plenty of blood flow to fuel the growth of new bone between the fused pieces, Dr. Claus explains. Smoking or using nicotine products can increase the odds of an unsuccessful spinal fusion.
The Benefits of Quitting
The good news is that it’s never too late to give up tobacco. Unfortunately, some damage to the spine is irreversible, and some pain might linger even after you quit. But giving up smoking can slow or stop the progression of that damage, Dr. Claus says. “The pain might not go away, but you can prevent it from getting worse,” he adds.
The study of Swedish construction workers, for example, showed that while heavy smokers were almost 50% more likely to need back surgery, ex-smokers were only 13% more likely to require such surgery.
Quitting can also improve the odds of a good surgical outcome if you decide to have an operation to treat your back pain. “Quitting a few months or even weeks before surgery can improve healing of the surgical site and lead to better bone growth after spinal fusion,” Dr. Claus says.
Quitting can make such a difference, in fact, that many insurance companies now require patients to stop smoking before a scheduled spine surgery.
If you need help cutting out nicotine, talk to your primary care doctor or a behavioral health specialist, Dr. Claus says. “No one is saying that it’s easy to stop smoking, but resources are available to support you in quitting,” he adds. Your back, and the rest of you, will benefit.
Reviewed by Chad F. Claus, D.O., a neurosurgeon at Henry Ford Michigan Spine & Brain Surgery, with locations in Novi, Rochester and Southfield. He specializes in cerebrovascular and endovascular surgery of the brain and spine, with additional subspecialty training in minimally invasive and complex spine surgery.
