{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:10:35Z","timestamp":1793171435432,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the impact of non-tobacco nicotine (NTN) dependence on pseudarthrosis and postoperative complications following posterior cervical fusion (PCF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The TriNetX national database was queried for adult patients (18-80 years) who underwent a primary posterior cervical fusion (2012-2025). Patients were stratified into 3 cohorts: non-tobacco nicotine-dependent (NTND) patients, tobacco-dependent (TD) patients, and non-dependent controls. Patients underwent propensity-score matching, and pairwise comparisons (NTND vs control, TD vs control, NTND vs TD) were performed. The primary outcome was pseudarthrosis development, and secondary outcomes included medical\/surgical complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 7102 patients were included. At 3 years, NTND patients had higher rates of pseudarthrosis (2.51% vs 1.84%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.019) compared to matched controls. Compared to controls at 3 months and 3 years, NTND was associated with significantly higher risks of all other postoperative complications (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05) except DVT. Compared to controls, TD patients had higher rates of all postoperative complications at 3 months and 3 years, except pseudarthrosis (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Compared to TD patients, NTND patients had higher rates of cervical fracture and pneumonia at 3 months (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05), and higher rates of cervical fracture at 3 years (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). At 3 months, the NTND cohort demonstrated lower rates of opioid abuse\/dependence, readmission, and emergency service use (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non-tobacco nicotine dependence is associated with risk of perioperative and long-term complications following posterior cervical fusion compared to control patients, yet is not significantly different from TD patients. Providers may consider this data during preoperative counseling and surgical optimization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261454228","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:32:21Z","timestamp":1781710341000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Non-Tobacco Nicotine Is Associated With Increased Complications Following Posterior Cervical Fusion: A Retrospective Cohort Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0082-1648","authenticated-orcid":false,"given":"Alec M.","family":"Giakas","sequence":"first","affiliation":[{"name":"Rothman Orthopaedic Institute"},{"name":"at Thomas Jefferson University 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