Smoking has been linked to worsening cervical degenerative disc disease in the cervical spine and can therefore increase the risk of chronic neck pain, according to research presented at the Association of Academic Physiatrists (AAP) 2016 meeting in Sacramento, California.

“Smoking is not healthy for a person’s intervertebral discs given the risk of developing microvascular disease — a disease of the small blood vessels — due to nicotine abuse,” said Mitchel Leavitt, MD, from the Emory University Department of Physical Medicine and Rehabilitation, in a statement.

“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.”

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While smoking has been associated with degeneration in the lumbar spine, no studies had yet made this association with the cervical spine.

To evaluate the association between cigarette smoking and cervical degenerative disc disease, the researchers reviewed 182 CT scans of patients (57% women; n = 103) that had been conducted at a university hospital for various reasons. Of the 182 patients, 61 were smokers (34%).

The researchers rated each disk as normal (no loss of disc height), mild (1% to 33% loss of disk height), moderate (34% to 66% loss of disk height), or severe (greater than 66% loss of disc height, or having the condition called vacuum disk in which gas has accumulated in the disks). Numerical scores were given to each disk from 0 (normal) to 3 (severe), and the entire cervical spine was then given a cumulative score ranging from 0 to 15.

The researchers also found each patient’s smoking status and number of pack years smoked (the number of packs smoked a day multiplied by the number of smoking years). The researchers also collected the patients’ age and body mass index, as well as whether or not the patients had high blood pressure, high cholesterol, or diabetes.

The researchers found that current smokers were found to have more severe cervical degenerative disk disease after controlling for age (p=0.0203). Active smokers had a worse cumulative degenerative disk disease score by an average of 1 point. They found no statistical significance for pack years (p=0.164).

Age was also correlated with worsening cervical degenerative disk disease (correlation coefficient 0.636, p < 0.0001). No correlation between worsening cervical degenerative disk disease and the comorbidities of diabetes, hypertension, hyperlipidemia, or high BMI was found.

“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,” Dr Leavitt said in a statement. “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.”

Summary and Clinical Applicability

“Virtually everyone knows that moderate exercise somewhere around 4 to 5 times per week is beneficial, plus other lifestyle factors like avoidance of smoking and a proper diet are equally important,” said Dr Leavitt in a statement. “However, these topics are usually geared towards heart health, lowering blood pressure, managing diabetes, or controlling other medical conditions, and [are] 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.”

More research should be conducted on other lifestyle factors and how they relate to chronic neck and back pain — (such as high-fat diets vs plant-based diets, alcohol use, obesity, etc) — as well as identifying any objective changes on advanced imaging or autopsy, Dr Leavitt noted. 

“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,” he added.


Leavitt M, Beckworth W. Abstract. Smoking and Cervical Degenerative Disc Disease as Seen on Computed Tomography. Presented at: AAP 2016. February 16-20, 2016; Sacramento, California.

This article originally appeared on Clinical Pain Advisor