The Relationship of SmokingOpioidAntidepressant Use and History of Spine Surgery

Introduction: In a recent paper, smoking was shown to be an independent predictor of longterm continued opioid use in spine patients (Krebs et al. 2010). In this paper, we study the interaction of smoking with opioid and antidepressant use and the relationship with prior spine surgery and future spine surgery. Methods: Data on smoking, opioid and antidepressant use were retrospectively collected from 758 spine surgery inpatients [lumbar microdiskectomy (LMD), anterior cervical decompression and fusion (ACDF) and lumbar decompression and fusion (LDF)]. Interaction with history of previous spine surgery and return for additional spine surgery was studied. Followup ranged from one to four years. Results: Significant correlation was detected between smoking and opioid use and between opioid and antidepressant use. History of previous spine surgery correlated with antidepressant use and return for additional spine surgery. Additional spine surgery correlated with opioid use and history of previous spine surgery. Smoking LMD patients on both opioids and antidepressants and smoking ACDF patients on antidepressants who have a history of prior spine surgery were more likely to return for additional spine surgery. However, in the LDF group, smoking patients on antidepressants without previous spine surgery were more likely to come for another spine surgery. Conclusion: Smokingantidepressantopioid use could be predictive of return for additional spine surgery during the followup years especially if a history of prior spine surgery was reported. Further research is needed on the implications of such an association.