Smoking linked to cervical degenerative disc disease


Smoking has been associated with worsening degenerative disc disease in the cervical spine in research from Emory University, Atlanta, USA.

Whilst smoking has previously been connected with lumbar degeneration, this study has associated it with degeneration of the cervical spine. The research team, led by Mitchel Leavitt, resident physician, Department of Physical Medicine and Rehabilitation, Emory University, analysed the computed tomography (CT) scans of 182 consecutive patients, who had been scanned for various reasons.

The research was presented at the Association of Academic Physiatrists Annual Meeting (AAP; 16-20 February, Sacremento, USA).

“Smoking is not healthy for a person’s intervertebral discs given the risk of developing microvascular disease…due to nicotine abuse,” Leavitt explains. “Intervertebral discs receive their nourishment from the microvasculature that line the endplates on either side of each disc; when these blood vessels are damaged, the discs do not receive nourishment and this may speed up the degenerative process,” he continues.

“There are more and more high-quality studies coming out that show an association between healthy lifestyle and improved quality and quantity of life as well as better disease management. Spine health is no different, and this study adds to existing studies that have looked at blood vessel health as it relates to chronic back pain,” Leavitt says.

The patients evaluated by Leavitt’s team were mostly female 57%, and 34% were smokers. The researchers utilised a radiologist with subspecialty training in neuroradiology and a physiatrist to review the CT scans.

Each disc was rated as normal (no loss of disc height), mild (1–33% loss of disc height), moderate (34 –66% loss of disc height), or severe with (>66% loss of disc height, or presenting with vacuum disc). Based on this, scores of zero (normal) to three (severe) were given to each disc, and a cumulative cervical degenerative disc disease score was given for the entire cervical spine with a range of 0–15.

The researchers considered each patient’s smoking status and his or her number of pack years smoked (thee number of packs of cigarettes smoked each day x the number of years he or she has smoked). Finally, the researchers collected and considered other health information such as age, body mass index (BMI), hypertension, high cholesterol and diabetes.


Current smokers were found to have more cervical degenerative disc disease by one point, on average. Additionally, the researchers found that increased age was associated with worsening cervical degenerative disc disease, but comorbidities – such as diabetes, hypertension, high cholesterol and high BMI – were not associated with the disease.

“This is another example of the detrimental effects of smoking. Tobacco abuse is associated with a variety of diseases and death, and there are lifestyle factors associated with chronic neck pain,” explains Leavitt. “Pain and spine clinics are filled with patients who suffer chronic neck and back pain, and this study provides the physician with more ammunition to use when educating them about their need to quit smoking.”

Leavitt suggests more research should be conducted on other lifestyle factors (diet, alcohol use, obesity, etc.) as they relate to chronic back and neck pain, as well as identifying any objective changes on advanced imaging or autopsy.

“As the population continues to get older, more and more patients are wanting, if not demanding, that they be given the opportunity to be as active as they were in their 40s. They want to play golf, run triathlons, work in their garden, etc.; however, chronic pain originating from the spine makes these activities difficult,” says Leavitt. “Virtually everyone knows that moderate exercise…is beneficial…However, these topics are usually geared towards heart health, lowering blood pressure, managing diabetes, or controlling other medical conditions, and not specific to the spine. It is one thing to live to the age of 95, and it is another to live to 95 while retaining one’s mobility and being free of pain. Lifestyle medicine will likely play a large role in the future of healthcare, and having plenty of data to support lifestyle management is critical for a provider who practices evidenced-based medicine. The lifestyle approach may allow us to not only live longer and healthier lives, but we may also be able to take less medication in the process, thereby sparing us the risk of medication side effects.”