The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2

Mohamed Macki, Sbaa Syeda, Kenan R. Rajjoub, Panagiotis Kerezoudis, Ali Bydon, Jean Paul Wolinsky, Timothy Witham, Daniel M. Sciubba, Mohamad Bydon, Ziya Gokaslan

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Abstract

Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.

Original languageEnglish (US)
Pages (from-to)459-464
Number of pages6
JournalWorld Neurosurgery
Volume97
DOIs
StatePublished - Jan 1 2017

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Arthrodesis
Reoperation
Pseudarthrosis
Smoking
Logistic Models
Spinal Diseases
Spinal Fusion
Incidence
Inpatients
Length of Stay
Spine
Confidence Intervals
Population

Keywords

  • Adjacent segment disease
  • Bone morphogenetic protein
  • Instrumented fusion
  • Reoperation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Macki, M., Syeda, S., Rajjoub, K. R., Kerezoudis, P., Bydon, A., Wolinsky, J. P., ... Gokaslan, Z. (2017). The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2. World Neurosurgery, 97, 459-464. https://doi.org/10.1016/j.wneu.2016.10.030

The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2. / Macki, Mohamed; Syeda, Sbaa; Rajjoub, Kenan R.; Kerezoudis, Panagiotis; Bydon, Ali; Wolinsky, Jean Paul; Witham, Timothy; Sciubba, Daniel M.; Bydon, Mohamad; Gokaslan, Ziya.

In: World Neurosurgery, Vol. 97, 01.01.2017, p. 459-464.

Research output: Contribution to journalArticle

Macki, M, Syeda, S, Rajjoub, KR, Kerezoudis, P, Bydon, A, Wolinsky, JP, Witham, T, Sciubba, DM, Bydon, M & Gokaslan, Z 2017, 'The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2', World Neurosurgery, vol. 97, pp. 459-464. https://doi.org/10.1016/j.wneu.2016.10.030
Macki, Mohamed ; Syeda, Sbaa ; Rajjoub, Kenan R. ; Kerezoudis, Panagiotis ; Bydon, Ali ; Wolinsky, Jean Paul ; Witham, Timothy ; Sciubba, Daniel M. ; Bydon, Mohamad ; Gokaslan, Ziya. / The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2. In: World Neurosurgery. 2017 ; Vol. 97. pp. 459-464.
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title = "The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2",
abstract = "Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6{\%}) were nonsmokers and 28 (25.5{\%}) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32{\%} incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4{\%} incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95{\%} confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.",
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author = "Mohamed Macki and Sbaa Syeda and Rajjoub, {Kenan R.} and Panagiotis Kerezoudis and Ali Bydon and Wolinsky, {Jean Paul} and Timothy Witham and Sciubba, {Daniel M.} and Mohamad Bydon and Ziya Gokaslan",
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AU - Macki, Mohamed

AU - Syeda, Sbaa

AU - Rajjoub, Kenan R.

AU - Kerezoudis, Panagiotis

AU - Bydon, Ali

AU - Wolinsky, Jean Paul

AU - Witham, Timothy

AU - Sciubba, Daniel M.

AU - Bydon, Mohamad

AU - Gokaslan, Ziya

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N2 - Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.

AB - Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.

KW - Adjacent segment disease

KW - Bone morphogenetic protein

KW - Instrumented fusion

KW - Reoperation

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