2026, Number 4
Spine surgery in the mexican population: influence of smoking on postoperative pain, functional disability, and quality of life
Mejía ADM, Pérez HL, Núñez SAJ, López HFC, López CC, Martínez TA
Full text
10.35366/123543
Language: Spanish
References: 13
Page: 274-282
PDF size: 749.31 Kb.
ABSTRACT
Introduction: degenerative lumbar spine disorders are among the leading causes of chronic pain, disability, and reduced quality of life worldwide. Conditions such as lumbar disc herniation, spinal stenosis, degenerative spondylolisthesis, and degenerative disc disease impose a substantial socioeconomic burden due to their impact on functional capacity and healthcare resource utilization. Low back pain is currently recognized as one of the most significant contributors to years lived with disability and remains a major public health concern. In Mexico, its prevalence continues to rise as a consequence of population aging and increasingly sedentary lifestyles. When conservative treatment fails or neurological deficits, spinal instability, or severe functional impairment are present, spine surgery becomes an effective therapeutic option to relieve pain, improve function, and restore patients’ quality of life. Despite advances in surgical techniques and perioperative care, postoperative outcomes are influenced by several patient-related factors, including age, comorbidities, adherence to rehabilitation programs, and modifiable lifestyle habits such as smoking. Smoking has been identified as one of the most important risk factors associated with unfavorable outcomes following spine surgery. The toxic components of tobacco smoke impair microcirculation, reduce tissue oxygenation, alter osteoblastic activity, and interfere with inflammatory mediators and molecular pathways involved in bone formation and healing. These effects may compromise spinal fusion, increase the risk of pseudarthrosis, delay tissue healing, and negatively affect functional recovery. Furthermore, previous studies have demonstrated that smokers experience higher levels of residual pain, greater functional disability, and poorer quality of life after spinal procedures compared with non-smokers. Although the detrimental effects of smoking on spinal surgery outcomes have been reported internationally, evidence regarding its impact in the Mexican population remains limited. Identifying modifiable prognostic factors is essential to optimize postoperative outcomes and develop effective perioperative strategies aimed at improving patient recovery. Therefore, the objective of this study was to evaluate the influence of smoking on postoperative pain, functional disability, and quality of life in Mexican patients undergoing surgery for degenerative lumbar spine disease. Objective: to evaluate the influence of smoking on clinical, functional, and quality-of-life outcomes in patients undergoing lumbar spine surgery for degenerative pathology, as well as to determine the impact of postoperative rehabilitation on these outcomes. Material and methods: an observational analytical study was conducted in 83 patients who underwent lumbar spine surgery for degenerative disease at the Hospital General del ISSSTE Saltillo. Pain (VAS), functional disability (ODI), and quality of life (EuroQol-5D) scores were assessed at three follow-up points: immediate, intermediate, and late postoperative periods. Among the patients, 25.3% were smokers and 74.7% non-smokers. Linear mixed models were used to analyze score evolution, including age, time, and the interaction with smoking status as fixed effects. Multiple comparisons were adjusted using the Bonferroni correction, with statistical significance set at p < 0.05. Results: both groups showed significant postoperative improvement. However, smokers consistently reported higher VAS scores than non-smokers throughout the follow-up period, with statistically significant differences from the immediate postoperative stage onward. In terms of disability, smokers had ODI scores 2-3 times higher than non-smokers (24.1 vs 9.8 in the immediate period; 22.6 vs 7.0 at late follow-up). Regarding quality of life, non-smokers exhibited a sustained improvement in EuroQol-5D scores (0.41), while smokers showed minimal or no recovery (−0.02). Smoking was independently associated with persistent pain, higher disability, and lower perceived well-being after surgery, regardless of age. Conclusions: smoking significantly and negatively affects postoperative recovery in patients with degenerative lumbar pathology, being associated with greater pain, increased disability, and poorer quality of life after surgery. Smoking cessation and adherence to structured rehabilitation programs should be considered essential components of comprehensive postoperative management. Institutional strategies promoting smoking cessation and standardized rehabilitation protocols are strongly recommended to optimize clinical and functional outcomes.REFERENCES