Smoking Increases the Risk of Reoperation After Anterior Cervical Disc Replacement

Retrospective cohort study.

Evaluate the effect of smoking on complication rates, radiographic parameters, and patient-reported outcomes (PROs) after anterior cervical disc replacement (ACDR).

ACDR is a motion-preserving procedure used to treat cervical radiculopathy and myelopathy. Although tobacco use is known to adversely affect outcomes after fusion-based procedures, its impact on ACDR remains underexplored.

Patients who underwent ACDR for myelopathy or radiculopathy between 2017 and 2025 at a single institution were identified and categorized as smokers or non-smokers. Outcomes included complication rates, global and segmental radiographic parameters (i.e. Cobb angle, range of motion [ROM]), and PROs (neck and arm Visual Analog Score, Neck Disability Index). Univariate analyses used chi-square and t-tests, and Firth logistic regression was applied for multivariate analysis of binary variables.

A total of 102 patients were included (19 smokers, 83 non-smokers). Baseline characteristics, including age, sex, BMI, and comorbidities, were similar between groups. Postoperatively, smokers demonstrated a significantly higher rate of reoperation than non-smokers (15.8% vs. 1.2%; P=0.003), all due to loosening or migration of the arthroplasty device. No significant differences were found in radiographic alignment or PROs, though smokers exhibited greater segmental ROM (9.5° vs. 6.8°; P=0.04).

While ACDR appears to preserve functional outcomes in smokers, tobacco use is associated with an increased risk of reoperation, likely resulting from reduced implant stability. Surgeons should monitor smokers closely postoperatively and consider enhanced follow-up for this at-risk population.