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Study design <p>Prospective multicenter cohort study.</p> Objectives <p>To evaluate the association of smoking status and cumulative smoking exposure with postoperative neurological outcomes in patients undergoing surgery for degenerative cervical myelopathy (DCM).</p> Setting <p>Multiple institutions in Japan.</p> Methods <p>A total of 935 patients with DCM were categorized as non-, past-, or current-smokers. Demographic characteristics, operative variables, and postoperative outcomes, including the Japanese Orthopaedic Association (JOA) score and recovery rate, JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), Short Form-36, visual analog scale, and Neuropathic Pain Symptom Inventory, were evaluated over a 2-year follow-up. Postoperative outcomes were analyzed across smoking categories using general linear models. Among current-smokers, cumulative smoking exposure was quantified using the Brinkman index and examined in relation to postoperative outcomes.</p> Results <p>Differences in postoperative functional outcomes, including the JOA recovery rate and JOACMEQ upper and lower extremity functions, were observed across smoking categories. In contrast, neurological recovery, health-related quality-of-life measures, pain intensity, and overall neuropathic pain scores were generally comparable between the groups. Among current-smokers, cumulative smoking exposure did not demonstrate a clear association with neurological or functional outcomes; however, exploratory analyses identified differences in improvement in specific neuropathic sensory symptoms.</p> Conclusion <p>Smoking status was associated with differences in postoperative functional recovery after DCM surgery. In contrast, cumulative smoking exposure among current-smokers showed exploratory associations with specific neuropathic sensory outcomes but not with overall neurological or functional recovery. These findings suggest that smoking status and cumulative exposure may influence different outcome domains, supporting smoking cessation as part of preoperative patient management.</p>

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Influence of smoking status and cumulative smoking exposure on neurological recovery after surgery for degenerative cervical myelopathy: a prospective multicenter study

  • 期刊论文

  • 发表日期：

    2026年5月7日

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  • Toshiki Okubo,
  • Narihito Nagoshi,
  • Junichi Yamane,
  • Hitoshi Kono,
  • Yoshiomi Kobayashi,
  • Reo Shibata,
  • Takahiro Kitagawa,
  • Kanehiro Fujiyoshi,
  • Kazuya Kitamura,
  • Takahito Iga,
  • Kazuki Takeda,
  • Masahiro Ozaki,
  • Satoshi Suzuki,
  • Morio Matsumoto,
  • Masaya Nakamura,
  • Kota Watanabe

摘要

Study design

Prospective multicenter cohort study.

Objectives

To evaluate the association of smoking status and cumulative smoking exposure with postoperative neurological outcomes in patients undergoing surgery for degenerative cervical myelopathy (DCM).

Setting

Multiple institutions in Japan.

Methods

A total of 935 patients with DCM were categorized as non-, past-, or current-smokers. Demographic characteristics, operative variables, and postoperative outcomes, including the Japanese Orthopaedic Association (JOA) score and recovery rate, JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), Short Form-36, visual analog scale, and Neuropathic Pain Symptom Inventory, were evaluated over a 2-year follow-up. Postoperative outcomes were analyzed across smoking categories using general linear models. Among current-smokers, cumulative smoking exposure was quantified using the Brinkman index and examined in relation to postoperative outcomes.

Results

Differences in postoperative functional outcomes, including the JOA recovery rate and JOACMEQ upper and lower extremity functions, were observed across smoking categories. In contrast, neurological recovery, health-related quality-of-life measures, pain intensity, and overall neuropathic pain scores were generally comparable between the groups. Among current-smokers, cumulative smoking exposure did not demonstrate a clear association with neurological or functional outcomes; however, exploratory analyses identified differences in improvement in specific neuropathic sensory symptoms.

Conclusion

Smoking status was associated with differences in postoperative functional recovery after DCM surgery. In contrast, cumulative smoking exposure among current-smokers showed exploratory associations with specific neuropathic sensory outcomes but not with overall neurological or functional recovery. These findings suggest that smoking status and cumulative exposure may influence different outcome domains, supporting smoking cessation as part of preoperative patient management.