Smoking Significantly Impairs Clinical Outcome Following Anterior Cervical Radiculopathy Surgery

Smoking impairs bone healing and vascularization, which may adversely affect recovery after spinal instrumented spondylodesis surgery. However, the effects of smoking on the clinical outcomes after anterior surgery for cervical radiculopathy remain unclear. (1) Is smoking associated with clinical outcomes after single-level ACDF? (2) Does smoking affect spinal fusion/stability? This retrospective cohort study included 482 patients who underwent single-level ACDF between May 2029 and November 2024, comprising 202 smokers and 208 non-smokers. The Visual Analogue Scale arm and neck pain, pain interference, pain intensity, physical function and the fusion/stability served as outcome measures. Data was collected at baseline, 3-, 6-, 12- and 24 months post-surgery and analysed using linear mixed-effects models. In addition, to evaluate outcomes at the level of individual success, predefined cut-off values were applied (arm pain ≤ 2.5, neck pain ≤ 3.5). The presence of spinal fusion was assessed on dynamic radiographs 6- and 12 months post surgery. Baseline characteristics were comparable. Over 24 months, smokers reported 1.65 points higher arm pain (p<0.001) and 1.56 points higher neck pain (p=0.003) compared to non-smokers. Moreover, at 24 months, non-smokers achieved higher successful outcomes for arm pain (71.0% vs 52.3%, p=0.043), but not for neck pain (73.1% vs 60%, p=0.158). Fusion/stability rates were similar at 6 months (56.1% versus 57.1%, p=0.943), but after 12 months, non-smokers demonstrated a higher fusion/stability rate (71.7% vs 51.4%, p=0.006). Non-smokers achieve both better long-term clinical outcomes and higher fusion/stability rates compared to smokers in ACDF surgery. • Smokers report higher arm pain one and two years after single-level ACDF. • Non-smokers achieve higher spinal fusion rates at 12 months follow-up. • Smoking status is associated with less favourable clinical outcomes. • Smoking status may be relevant in preoperative evaluation for ACDF.