Smoking causes cancer, lung disease and heart attacks, and disrupts body chemistry in such dangerous ways that a host of other ailments can result. So it's not surprising that even back problems might be caused by nicotine and smoke ingestion.

Indeed, the American Academy of Orthopaedic Surgeons (AAOS) says smoking diminishes the blood supply to the bones, and saps them of calcium, both of which increase the possibility of the onset of osteoporosis. Suggestive of the relationship between smoking and back issues, one's chances for success after back surgery improve dramatically if one is a nonsmoker or has ceased smoking.

"There have been several reviews on this topic, and it's something we're very interested in," says Dr. John Keel, medical director of the Spine Center at Beth Israel Deaconess Medical Center in Boston.

Investigators, says Keel, believe that the poisons in tobacco smoke (such as carbon monoxide and lead) reduce blood flow and the delivery of oxygen and nutrients to the bone and cartilage of the spine. The poor oxygenation induced by smoke toxins can also cause the intervertebral discs to become more brittle, increasing a smoker's risk for severe back pain through disc ruptures. In addition, some scientists theorize that "smoker's cough" can increase the pressure on the vertebrae and discs and cause pain or injury.

"Decreasing smoking is one of most important things you can do for back health," says Keel. "This is especially true if you are having spine surgery, because smoking also affects the ability of body tissues to heal."

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