Cigarette smoking dose as a predictor of need for surgical intervention in patients with lumbar disk herniation

Purpose: Numerous studies have investigated the significant relationship between sciatic pain, radiating lower back pain, lumbosacral radicular syndrome or other disk disorders and cigarette smoking; however, only few reports have demonstrated the relationship between the total smoking dose and lumbar disk herniation (LDH), a cause of lower back or sciatic pain. Furthermore, the relationship between total cigarette consumption and the need of surgical intervention for LDH has not yet been investigated. Materials and Methods: This study included 391 patients with symptomatic LDH. The control group comprised 431 inpatients admitted for other medical or surgical problems. Their demographic data and level of cigarette consumption were obtained through a chart review. The association between lumbar surgical intervention and the clinical characteristics were investigated by multiple logistic regression analyses, with stepwise selection. Results: Compared with the nonsmokers, the smokers had a 1.5-fold increased risk of developing LDH (P = 0.01). An increased total smoking dose (pack-years) was a risk factor of undergoing lumbar surgical intervention among the LDH patients (odds ratio [OR] = 1.02; P = 0.03). Furthermore, the risk of undergoing lumbar surgical intervention increased to 1.83 times among LDH patients with a 6-10-year smoking history and to 2.16 times among those with >10-year smoking history (P = 0.02 and P = 0.002, respectively). Conclusion: This study found that the total cigarette smoking dose was associated with LDH and was a risk factor for undergoing surgical intervention for LDH.