Maximize the ability to heal after spine fusion surgery Healing after spine surgery One of the risks of any spine fusion surgery is a lack of healing of the bone graft, which is known as a pseudarthrosis. There are a number of factors that can affect this outcome after spine fusion surgery. These can include: Poor nutrition Osteoporosis Previous back surgery Multiple level spine fusion surgery Severe deformities Medications (e.g. non-steroidal anti-inflammatories, cortisone and chemotherapy) Smoking Smoking and spine fusion Clearly some of the factors affecting the success of spine fusion surgery are outside of the patient’s control. Others are not. In particular, the evidence linking cigarette smoking and pseudarthrosis is very strong, and it has been clearly demonstrated that nicotine inhibits the bone growing cells (osteoblasts), which are necessary to achieve a successful spine fusion. For patients with back pain and/or planning a spine fusion surgery, the best time to quit smoking is right away. There is no appropriate time start again. Smoking has no health benefits and an overwhelming number of health risks, including the risk of back pain and the risk of failed spine fusion surgery. At the very least, the patient needs to commit to not smoking for at least three months after the spine fusion surgery, as this is the most critical time for bone healing.