Beeinflusst Rauchen Rückenschmerzen und spinale Operationsergebnisse?

Zusammenfassung

Hintergrund: Orthopädisch tätige Chirurgen vermuten seit Langem einen Einfluss des Rauchens auf verschiedene muskuloskeletale Erkrankungen. Ziel dieser Übersichtsarbeit ist es, den Einfluss des Rauchens auf Rücken- und Kreuzschmerzen (low back pain = LBP) und Ergebnisse spinaler Operationen zu diskutieren. LBP zählt zu den häufigsten Krankheiten der Bevölkerung und hat durch hohe direkte und indirekte Krankheitskosten eine große volkswirtschaftliche Bedeutung. Um präventive Bemühungen zielgerichtet anwenden zu können, müssen Risikofaktoren für LBP erkannt werden. Material und Methoden: Eine Analyse der Literatur (Pubmed mit den Suchbegriffen: smoking, low back pain and pathophysiology) wurde durchgeführt. Von den Suchergebnissen wurden 196 Publikationen aus Journalen mit Peer-Review-Verfahren ausgewertet (darunter 3 randomisierte klinische Studien, 134 klinische, 28 experimentelle Forschungsartikel und 31 Übersichtsarbeiten [darunter 1 Cochrane Database Review und 5 systematische Reviews]). Zusätzlich wurden 11 offizielle Veröffentlichungen des US Department of Health and Human Services (USA), der International Agency for Research on Cancer (Frankreich) und des Deutschen Krebsforschungszentrums ausgewertet. Ergebnisse: Während die Evidenzlage bezüglich negativer Auswirkungen des Rauchens auf Osteoporose sehr gut belegt ist, können zwar zahlreiche Assoziationen zwischen LBP und Rauchen, jedoch bisher kein kausaler Zusammenhang mit degenerativen Erkrankungen des Rückens nachgewiesen werden. Trotzdem ist aufgrund der plausiblen pathophysiologischen Mechanismen sowie der überwältigenden Anzahl positiv korrelierender Studien ein negativer Einfluss des Rauchens auf LBP und spinale Operationsergebnisse wahrscheinlich. Wie bei allen Erkrankungen mit multifaktorieller (inklusive psychosozialer) Genese wird die ätiologische Zuordnung zum Rauchen durch viele potenzielle Confounding-Effekte erschwert. Schlussfolgerung: Trotz Durchführung einer großen Anzahl von Studien, mithilfe derer ein möglicher Zusammenhang zwischen LBP und Rauchen untersucht wurde, konnte bisher kein abschließendes Ergebnis gezeigt werden. Dennoch gilt auf der Basis des heutigen Verständnisses ein negativer Einfluss von Rauchen auf LBP und spinale Operationsergebnisse als wahrscheinlich.

Abstract

Background: For a long time, orthopaedic surgeons have suspected an influence of smoking on several musculoskeletal diseases. The aim of this review is to discuss the influence of smoking on low back pain (LBP) and the outcome of spinal surgery. LBP is a highly prevalent disease and plays an important economic role, as it is associated with high direct and indirect health-care costs. In order to be successful in prevention, risk factors for LBP must be identified. Methods: A review of the literature (using PubMed with the search terms: smoking, low back pain and pathophysiology) was performed. Of the search results, 196 publications from peer-reviewed journals were analysed (including three randomised clinical trials, 134 clinical, 28 experimental articles and 31 reviews [including one Cochrane Database review and five systematic reviews]). Additionally, 11 official publications of the US Department of Health and Human Services, the International Agency for Research on Cancer (France) and the “Deutsches Krebsforschungszentrum” were used.Results: While the evidence level for severe adverse effects of smoking on osteoporosis is good, many studies performed on LBP describe a statistical association, but are not useful to detect a causal link between smoking and lumbar disease. However, with plausible pathophysiological mechanisms and an overwhelming number of studies identifying a correlation it is suggested that smoking is likely to contribute to LBP and affects spinal surgery adversely. As for all diseases with multifactorial (including psychosocial) aetiology, it proves difficult to distract the confounding factors for analysis. Conclusion: A high number of studies performed to identify an association between smoking and LBP have not led to a final conclusion. But still, on the basis of the current knowledge, a negative contribution of smoking on LBP and spinal surgery seems probable.

Schlüsselwörter

Rauchen - Rückenschmerzen - spinale Neurochirurgie - Rückenoperation - chronische Kreuzschmerzen

Key words

smoking - low back pain - spinal neurosurgery - spinal operation - chronic low back pain

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