Cigarette Smoking and Its Impact on Bones of Spine with its treatment

Cigarette Smoking
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Cigarette Smoking is the practice of smoking tobacco and inhaling tobacco smoke consisting of particle and gaseous phases. A more broad definition may include simply taking tobacco smoke into the mouth, and then releasing it, as is done by some with tobacco pipes and cigars. The practice is believed to have begun as early as 5000–3000 BC in Mesoamerica and South America.[1] Tobacco was introduced to Eurasia in the late 17th century by European colonists, where it followed common trade routes. The practice encountered criticism from its first import into the Western world onwards but embedded itself in certain strata of a number of societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.

German scientists identified a link between smoking and lung cancer in the late 1920s, leading to the first anti-smoking campaign in modern history, albeit one truncated by the collapse of Nazi Germany at the end of World War II. In 1950, British researchers demonstrated a clear relationship between smoking and cancer. Evidence continued to mount in the 1980s, which prompted political action against the practice. Rates of consumption since 1965 in the developed world have either peaked or declined.

Many people begin to smoke cigarettes (or use smokeless tobacco) despite published statistics that show its negative impact on health. The adverse effects of smoking include nicotine addiction, increased risk of lung and other types of cancer, higher rates of arteriosclerosis (hardening of the arteries) and heart disease, as well as decreased life expectancy. Plus, there are the effects of secondhand smoke, which are not covered in this article.

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  • Tobacco use is the leading preventable cause of death in the United States.
  • Smoking-related deaths in the United States is about 3 times higher than among people who never smoked.
  • Smokeless tobacco can cause cancer.

Cigarettes contain dried tobacco leaves and flavorings, which include more than 4,000 chemicals. Some of these substances are harmless until burned and breathed. Cigarette smoke can be divided into two categories: (1) distinct particles and (2) gases. The following table is a partial list of the substances in cigarette smoke.

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Distinct ParticlesGases
AnilineAcetone
BenzanthraceneCarbon Dioxide
CatecholCarbon Monoxide
HarmaneFormaldehyde
NapthaleneHydrazine
NicotineHydrogen Cyanide
PhenolNitrogen Oxides
QuinolinePyridine
Toluene3-Vinylpyridine

Cigarettes and the Body
Cigarette smoking adversely affects many of the body’s life-sustaining systems, as shown below.

Body SystemPurposeCigarettes’ Impact
RespiratoryVentilates the lungs, exchanges oxygen and carbon dioxide.Decreases lung function Increases mucous production, increases coughing, and possibly increases infections
Circulatory and blood vesselsDelivers oxygen and nutrients to cells and carries away carbon dioxide and waste.Hinders circulation due to plaque deposits and narrowing of blood vessels
Digestive tractBreaks food down into absorbable components to feed the body and eliminates waste.Irritates digestive tract and hinders absorption of nutrients

The Spine and Cigarette Smoking

Bone is a living tissue dependent on the functions and support provided by the other body systems. When these systems are not able to perform normally, bone is unable to rebuild itself. The formation of bone is particularly influenced by physical exercise and hormonal activity, both of which are adversely affected by cigarette smoking.

Many smokers have less physical endurance than nonsmokers, mainly due to decreased lung function. Cigarette smoking reduces the amount of oxygen in the blood and increases the level of harmful substances, such as carbon monoxide. This, combined with the effects of smoking on the heart and blood vessels, can limit the benefits from physical activity.

In men and women, cigarette smoking is known to influence hormone function. Smoking increases estrogen loss in women who are perimenopausal or postmenopausal. This can result in a loss of bone density and lead to osteoporosis. Osteoporosis causes bones to lose strength, becoming more fragile. This silent disease is responsible for many spine and hip fractures in the United States.

Spinal Fusion and Cigarette Smoking

Spinal fusion is a surgical procedure used to join bony segments of the spine (eg, vertebrae). In order for fusion to heal, new bone growth must occur, bridging between the spinal segments. Sometimes fusion is combined with another surgical technique termed spinal instrumentation. Instrumentation consists of different types of medically designed hardware such as rods, hooks, wires, and screws that are attached to the spine. These devices provide immediate stability and hold the spine in proper position while the fusion heals.

Spinal fusion (also termed arthrodesis) can be performed at the cervical, thoracic, or lumbar levels of the spine. It takes months to heal. Your doctor may order post-operative radiographs (x-rays) to monitor the progress of this healing.

The long-term success of many types of spinal surgery is dependent upon successful spinal fusion. In fact, if the fusion does not heal, spinal surgery may have to be repeated. A failed fusion is termed a nonunion or pseudoarthrosis. Spinal instrumentation, although very strong, may even break if nonunion occurs. Needless to say, spine surgeons try to minimize the risk of this happening by prescribing a bone growth stimulator.

Cigarette Smoking and Failed Fusion

Certain factors have been found to affect the success of spinal fusion. Some of these factors include the patient’s age, underlying medical conditions (eg, diabetes, osteoporosis), and cigarette smoking. There is growing evidence that cigarette smoking adversely affects fusion. Smoking disrupts the normal function of basic body systems that contribute to bone formation and growth. As mentioned previously, new bone growth is necessary for a fusion to heal.

Research has demonstrated that habitual cigarette smoking leads to the breakdown of the spine to such a degree that fusion is often less successful when compared to similar procedures performed on non-smokers.

Postoperative Infection

Cigarette smoking compromises the immune system and the body’s other defense mechanisms, which can increase the patient’s susceptibility to post-operative infection.

Smoking cessation medications

  1. Varenicline  – is a prescription medicine developed to help people stop smoking. It works by interfering with nicotine receptors in the brain. This means it has 2 effects:
  2.   Nortriptyline –This is an older anti-depressant drug that helps reduce tobacco withdrawal symptoms. It has been found to increase chances of success in quitting smoking when compared to those taking no medicine. It’s typically started 10 to 28 days before a person stops smoking to allow it to reach a stable level in the body.
  3.  Clonidine – is another older drug that has been shown to help people quit. It’s FDA- approved to treat high blood pressure. When used to quit smoking, it can be taken as a pill twice a day or worn as a skin patch that’s changed once-a-week.
  4. Naltrexone –  is a drug used to help those with alcohol and opioid abuse disorders. Studies are looking at ways to combine it with varenicline to help people quit smoking, especially  smokers who are also heavy drinkers.
  5. Bupropion- Bupropion is also used for people with depression. It helps with quitting tobacco even if you do not have problems with depression. It is not fully clear how bupropion helps with tobacco cravings.

All avobe mention drug are not available ,but bupropion are available

Bupropion should not be used for people who

  • Are under age 18.
  • Are pregnant.
  • Have a history of medical problems such seizures, kidney failure, heavy alcohol use, eating disorders, bipolar or manic depressive illness, or a serious head injury.

How to take it

  • Start bupropion 1 week before you plan to stop smoking. Your goal is to take it for 7 to 12 weeks.  Talk with your doctor before taking it for a longer period of time.
  • The most common dose is a 150 mg tablet once or twice a day with 8 hours between each dose. Swallow the pill whole. DO NOT chew, split, or crush it. Doing so can cause side effects, including seizures.
  • If you need help with cravings when first quitting, you may take bupropion along with nicotine patches, gums, or lozenges. Ask your doctor if this is OK for you.

Side effects of this medicine may include

  • Problems sleeping. Try taking the second dose in the afternoon if you have this problem (take it at least 8 hours after the first dose).
  • Stop taking this medicine right away if you have changes in behavior. These include anger, agitation, depressed mood, thoughts of suicide, or attempted suicide.

VARENICLINE

Varenicline (Chantix) helps with the craving for nicotine and withdrawal symptoms. It works in the brain to reduce the physical effects of nicotine. This means that even if you start smoking again after quitting, you will not get as much pleasure from it when you are taking this drug.

How to take it:

  • Start taking this medicine 1 week before you plan to quit cigarettes. You will take it for 12 to 24 weeks.
  • Take it after meals with a full glass of water.
  • Your provider will tell you how to take this medicine. Most people take one 0.5 mg pill a day at first. By the end of the second week, you will likely be taking a 1 mg pill twice a day.
  • DO NOT combine this drug with nicotine patches, gums, sprays or lozenges.
  • Children under age 18 should not take this drug.

Most people tolerate varenicline well. Side effects are not common, but can include the following if they do occur:

  • Headaches, problems sleeping, sleepiness, and strange dreams.
  • Constipation, intestinal gas, nausea, and changes in taste.
  • Depressed mood, thoughts of suicide and attempted suicide. Call your doctor right away if you have any of these symptoms.

NOTE: Use of this medicine is linked to an increased risk of heart attack and stroke.

Other Medicine

The following medicines may help when other treatments have not worked. The benefits are less consistent, so they are considered second-line treatment.

  • Clonidine is normally used to treat high blood pressure. It may help when it is started before quitting. This drug comes as a pill or patch.
  • Nortriptyline is another antidepressant. It is started 10 to 28 days before quitting.

References

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  9. Peto, Richard; Lopez, Alan D; Boreham, Jillian; Thun, Michael (2006). “Mortality from Smoking in Developed Countries 1950-2000: indirect estimates from national vital statistics” (PDF). Oxford University Press: 9. Retrieved 22 March 2009.
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