Smoking Increases the Risk of Reoperation After Anterior Cervical Disc Replacement.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spine Surgery

Background:

• Anterior cervical disc replacement (ACDR) is a motion-preserving surgery for cervical radiculopathy/myelopathy.
• Tobacco use negatively impacts outcomes in spinal fusion but its effect on ACDR is less understood.

Purpose of the Study:

• To assess the impact of smoking on complication rates, radiographic parameters, and patient-reported outcomes (PROs) following ACDR.
• To compare outcomes between smokers and non-smokers undergoing ACDR.

Main Methods:

• Retrospective cohort study of 102 patients undergoing ACDR (2017-2025).
• Patients were categorized as smokers (n=19) or non-smokers (n=83).
• Outcomes analyzed included complications, radiographic parameters (Cobb angle, ROM), and PROs (VAS, NDI) using statistical tests and Firth logistic regression.

Main Results:

• Smokers had a significantly higher reoperation rate (15.8% vs. 1.2%, P=0.003) due to device loosening/migration.
• No significant differences in radiographic alignment or PROs were observed between groups.
• Smokers showed greater segmental range of motion (ROM) postoperatively (9.5° vs. 6.8°, P=0.04).

Conclusions:

• ACDR preserves functional outcomes in smokers, but smoking increases reoperation risk.
• Reduced implant stability is the likely cause of increased reoperations in smokers.
• Enhanced postoperative surveillance for smokers undergoing ACDR is warranted.