{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T15:15:38Z","timestamp":1793718938302,"version":"4.6.1"},"reference-count":65,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Cerapedics Inc"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review with meta-analysis is aimed at evaluating the impact of smoking (tobacco) on spinal fusion rates and the resulting PROMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following the PRISMA guidelines, a systematic literature search was conducted in 4 databases. Studies focused on adult smokers vs non-smokers undergoing spinal fusion. Odds ratios (ORs) were calculated for dichotomous variables and mean differences or standardized mean differences for continuous variables. The primary outcomes assessed were non-union\/pseudoarthrosis incidence and PROMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 29 studies were included in this analysis. The unadjusted incidence of pseudoarthrosis was significantly higher in smokers than in non-smokers (OR 1.97, 95% CI 1.55-2.52,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Subgroup analysis revealed significant differences in the cervical (OR 2.09, 95% CI 1.27-3.44,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05) and lumbar (OR 1.97, 95% CI 1.45-2.68,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) regions. Adjusted analysis also showed a significantly higher incidence of pseudoarthrosis in smokers (OR 1.38, 95% CI 1.12-1.72,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Changes in ODI, VAS, EQ-5D, and SF-12 and SF-36, consistently favored nonsmoking patients. Smoking was associated with a lower rate of returning to work (OR 0.70, 95% CI 0.54-0.90,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05), and in the lumbar subgroup, reduced satisfaction (OR 0.24, 95% CI 0.12-0.49,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Former smokers (smoking cessation for at least 1 year prior to surgery) did not show significant differences compared to nonsmokers in terms of pseudarthrosis rate or pain scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Smoking is associated with an increased risk of pseudarthrosis and poorer PROMs after spinal fusion surgery. Healthcare providers should emphasize smoking cessation interventions to improve surgical outcomes and patient satisfaction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251383167","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:04:53Z","timestamp":1760033093000},"page":"1329-1348","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Adverse Impact of Smoking on Spine Fusion and Patient-Reported Outcomes: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4622-7695","authenticated-orcid":false,"given":"P.M.","family":"Arnold","sequence":"first","affiliation":[{"name":"Loyola University Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.S.","family":"Harrop","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5166-198X","authenticated-orcid":false,"given":"G.","family":"Mariscal","sequence":"additional","affiliation":[{"name":"Valencia Catholic University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.C.","family":"Sasso","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.P.","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.D.","family":"Chaput","sequence":"additional","affiliation":[{"name":"The University of Texas Health Science Center at San Antonio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.B.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.D.","family":"Witiw","sequence":"additional","affiliation":[{"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.E.","family":"O'Toole","sequence":"additional","affiliation":[{"name":"Rush University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000254104.55716.46"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0b013e318269cc4a"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.05.010"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200010150-00008"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200001010-00007"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2012.5"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0025544"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0025544"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6845a2"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200112010-00018"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200010150-00011"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.01598"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002293"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.6.SPINE13762"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.11.157"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.08.026"},{"issue":"2","key":"e_1_3_6_18_2","first-page":"20","article-title":"Bone allograft with mesenchymal stem cells: a critical review of the literature","volume":"2","author":"Grabowski G","year":"2013","unstructured":"Grabowski G, Robertson RN. 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