Impact of Smoking On Surgical Outcomes For Patients Undergoing Cervical Surgery: A Systematic Review And Meta-Analysis

Objective: To determine whether smoking has adverse effects on outcomes following cervical surgery.Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science through 13 July 2021 for cohort and case-control studies that investigated the effect of smoking on outcomes after cervical surgery. Two researchers independently screened the studies and extracted data according to the selection criteria.Results: The meta-analysis included 43 studies, including 27 case-control studies and 16 cohort studies, with 10020 patients. Pooled estimates showed that smoking was associated with higher rates of overall complications (odds ratio [OR]=2.00, 95% confidence interval [CI]: 1.63-2.44, p<0.00001), respiratory complications (OR=3.14, 95% CI: 1.94-5.08, p<0.00001), reoperation (OR=2.22, 95% CI: 1.41-3.49, p=0.005), dysphagia (OR=1.49, 95% CI: 1.07-2.07, p=0.02), wound infection (OR=3.19, 95% CI: 1.64-6.21, p=0.0006), axial neck pain (OR=1.97, 95% CI: 1.25-3.10, p=0.003), and a lower rate of fusion (OR=0.63, 95% CI: 0.49-0.81, p=0.0003). There were no significant differences between smoking and non-smoking groups in terms of operation time (mean difference [MD]=0.08, 95% CI: - 5.54 to 5.71, p=0.98), estimated blood loss (MD=-5.31, 95% CI: -148.83 to 139.22, p=0.94), length of hospital stay (MD=1.01, 95% CI: -2.17 to 4.20, p=0.53), Visual Analog Scale-neck pain (MD=-0.19, 95% CI: -1.19 to 0.81, p=0.71), Visual Analog Scale-arm pain (MD=-0.50, 95% CI: -1.53 to 0.53, p=0.34), Neck Disability Index (MD=11.46, 95% CI: -3.83 to 26.76, p=0.14), and Japanese Orthopaedic Association Scores (MD=-1.75, 95% CI: -5.27 to 1.78, p=0.33).Conclusions: Smokers appear to be more likely than non-smokers to suffer higher rates of overall complications, respiratory complications, reoperation, longer hospital stay, dysphagia, wound infection, axial neck pain, and a lower fusion rate following cervical surgery. It is essential to provide timely smoking cessation advice and explanation to patients before selective cervical surgery.

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Background Cervical sagittal alignment (CSA) is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK. Methods Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analog scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP. Results Patients who complained of ANP were categorized as ANP group (VAS score ≥ 3; n = 92), while those without ANP were categorized as non-ANP group (VAS score < 3; n = 171). There was no significant between-group difference with respect to age (P = 0.196), gender (P = 0.516), TIA (P = 0.139), NT (P = 0.676), CK type (P = 0.533), cranial tilt (P = 0.332), cervical tilt (P = 0.585), or cervical disk degeneration (P = 0.695). The T1 slope and C2-7 SVA in the ANP group were significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [ odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P = 0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P = 0.028) were identified as risk factors for ANP. Conclusions Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Background: Cervical sagittal alignment (CSA) is closely related with cervical disc degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK.Methods: Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analogue scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP.Results: Patients who complained of ANP were categorized as ANP group (VAS score≥3; n=92), while those without ANP were categorized as non-ANP group (VAS score<3; n=171). There was no significant between-group difference with respect to age (P=0.196), gender (P=0.516), TIA (P=0.139), NT (P=0.676), CK type (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585), or cervical disc degeneration (P=0.695). The T1 slope and C2-7 SVA in the ANP group was significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P=0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P=0.028) were identified as risk factors for ANP.Conclusions: Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Background:Cervical sagittal alignment is closely related with cervical disc degeneration and impacts the spinal function and quality of life, especially for cervical kyphosis (CK). The purpose of this study was to evaluate the influence of cervical sagittal parameters on the axial neck pain (ANP) in patients with CK.Methods: A retrospective analysis was performed of data from 263 patients who underwent to the authors’ department of this institution between January 2012 and December 2018. Radiographic evaluations were performed at authors’ department, including CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt and cervical tilt. Sagittal alignment of the cervical spine was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to evaluate these parameters as the risk factors for ANP.Results: Patients in this study were divided into 2 groups according to ANP. There were 92 patients in ANP group and 171 patients in Non-ANP group. There was no significant difference in age (P=0.196), gender (P=0.516), TIA(P=0.139), NT (P=0.676), CK types (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585) and cervical disc degeneration (P=0.695) between the two groups. T1 slope, C2-7 SVA in the ANP group was significantly higher than in the Non-ANP group (P < 0.05). After multivariate logistic regression analysis, C2-7 SVA (P=0.003, OR 2.318, 95% CI 1.373-4.651) and T1 slope (P=0.028, OR 2.563, 95% CI 1.186-4.669) were the two risk factors for the ANP.Conclusions: Based on this study, cervical sagittal parameters have a significant effect on the happening of axial neck pain in patients with CK. A higher T1 slope and larger C2-7 SVA are closely lead to the development of neck pain.