Evolving Technique: The Effect of Smoking and Ketorolac on Spinal - - PowerPoint PPT Presentation

Evolving Technique: The Effect of Smoking and Ketorolac on Spinal Surgery

Stephen Curtin MD

Tucson Orthopeadic Institute Tucson, AZ

Smoking

• Inhaled
• rganics/smoke
• Nicotine
• “Health”
• Fusion
• Wound/soft

tissue problems

• Philosophy and

strategy

Smoking and Spinal Surgery

The effect of nicotine on spinal fusion.

DH Silcox III, T Daftari, SD Boden, JH Schimandle… - Spine, 1995

The effect of cigarette smoking and smoking cessation on spinal fusion

SD Glassman, SC Anagnost, A Parker, D Burke… - Spine, 2000

Effects of a Perioperative Smoking Cessation Intervention on Postoperative Complications: A Randomized Trial

Lindström, David MD, PhD*; Azodi, Omid Sadr MD†; Wladis, Andreas MD, PhD*; …Annals of Surgery: November 2008 -Volume 248 - Issue 5 - pp 739-745

Cigarette smoking increases complications following fracture: a systematic review

JA Scolaro, ML Schenker, S Yannascoli, K Baldwin… - JBJS, 2014

Cigarette Smoke

4000 Identified Substances Cellular level

• Nicotine
• Vasoconstrictive
• Platelet aggregation
• Carbon monoxide
• Displaces oxygen from Hgb
• Hydrogen cyanide
• Inhibits mitochondrial cytochrome
• xidase
• Alteration of Cytokine Genes

associated with:

• Neovascularization
• Osteoblast differentiation
• BMP’s
• Fibroblast growth factor
• Collagen synthesis

Smoking and Spinal Surgery Pseudo arthrosis

• Multiple adverse

affects

• 2X-5X Pseudo arthrosis
• Vaping
• Nicotine is nicotine
• Medical Marijuana
• Inhaled organic
• Strategies for quitting
• Chantix, Zyban, NRT
• BMP

Ketorolac and Spinal Surgery

Pro Con

• Non-narcotic

pain relief

• Bleeding
• Gastrointestinal
• Pseudo

arthrosis

Ketorolac and Spinal Surgery

• The Effect of Postoperative Nonsteroidal Anti-inflammatory Drug

Administration on Spinal Fusion

• SD Glassman, SM Rose, JR Dimar, RM Puno… - Spine, 1998
• Ketorolac and spinal fusion: does the perioperative use of ketorolac

really inhibit spinal fusion?

• BB Pradhan, RL Tatsumi, J Gallina, CA Kuhns… - Spine, 2008
• High-dose ketorolac affects adult spinal fusion: a meta-analysis of the

effect of perioperative nonsteroidal anti-inflammatory drugs on spinal fusion

• QLi, Z Zhang, Z Cai - Spine, 2011
• The Effect of Ketorolac on Spinal Fusion: What Is the Evidence?
• J Li, RM Ajiboye, A Sharma, AO Ashana… NASS 31st Annual Meeting Proceedings,2016

Ketorolac and Spinal Surgery

Non-fusion Surgery Fusion Surgery

• Excellent for Post
• perative pain

management

• Standard GI precautions

for NSAIDs

• Bleeding not an issue with

normal clotting parameters

• Dose limitations (5 days)
• Dose dependent
• High dose(>120mg/day)

and long duration (>2days) are bad

• Low dose(<120mg/day)

and short duration(<2days) are OK

• Adversely synergistic with

smoking