Tobacco

By Edward S. Pratt, M.D., M.B.A.

It has been estimated that two thirds of those who smoke will die from complications associated with cigarette smoking. Although the popularity of smoking as a habit dropped through the last decade of the twentieth century, it is again on the rise. It is risk taking young adults that are largely responsible for this rise. Besides causing profound increases in most forms of cancer, chronic obstructive pulmonary disease and heart disease, cigarette smoke also affects your friend the back.

Twenty three very unusual and specialized structures within each of our spines, extending from the base of your skull to your pelvis are the intervertebral discs. These structures are specialized joints made of cartilage and fibrous tissue. One of the ways they are unusual is that they are the largest structures in the body without a specific blood supply. Each disc is surrounded by small blood vessels, but few if any penetrate into the disc itself. For cells inside the disc to receive nourishment and oxygen, these nutrients must diffuse out of the blood vessels around the periphery of the disc and into the disc itself. This passage of nutrients is aided by a gradual squeezing of fluid out of the disc during the day with weight bearing, and a gradual rehydration at night that occurs while you are asleep. This process is inhibited by nicotine. Nicotine in cigarette smoke is a very powerful vasoconstricting agent. In other words, it makes blood vessels spasm, and the amount of blood flow drop off or stop all together. The cells within the disc then, one by one begin to starve to death, and the disc gradually looses volume, and strength, leading to premature degenerative disc disease. Once the damage is done it cannot be reversed. This may not seem like a problem to you, as a young adult, but it makes your friend the back very unhappy, and over time the arthritis that develops in each disc can become so widespread that even surgical fusion procedures cannot effectively control the disabling pain. The bottom line?  Smoke at your own risk…and that of your friend your back.