Dr. Marc Greenberg Co-Authors Study: Smoking Increases Reoperation Risk After Cervical Disc Replacement

A peer-reviewed study published in the journal Spine in February 2026 finds that smoking is associated with a higher risk of reoperation after anterior cervical disc replacement.

Dr. Marc Greenberg, a fellowship-trained minimally invasive spine surgeon in Fort Wayne, Indiana, is a co-author of a peer-reviewed study published in the journal Spine in February 2026. The study examines how smoking affects outcomes after anterior cervical disc replacement (ACDR), a motion-preserving surgery for cervical radiculopathy or myelopathy.

The study adds evidence about a potential risk factor, but its design and sample size limit what can be concluded for an individual patient.

Full Citation

Shah I, Sadh P, Sheth S, Suleman Y, Greenberg M, Foster T, Basques BA.

Smoking Increases the Risk of Reoperation After Anterior Cervical Disc Replacement.

Spine. 2026 Feb. doi:10.1097/BRS.0000000000005675.

What the Study Examined

This was a single-institution retrospective study that reviewed 102 patients — 19 smokers and 83 non-smokers — who all underwent anterior cervical disc replacement for cervical radiculopathy or myelopathy between 2017 and 2025.

The researchers compared several outcomes between the smoker and non-smoker groups:

Complication Rates

Including reoperation rates and the specific reasons patients needed a second surgery after their cervical disc replacement.

Radiographic Measurements

Including spinal alignment on imaging and how much motion the artificial disc preserved over time.

Patient-Reported Outcomes

How patients rated neck pain, arm pain, and disability after surgery.

The goal was to understand whether tobacco use meaningfully changed the results patients could expect from cervical disc replacement — both in terms of how the implant performed and how patients felt.

What the Study Found

The study revealed several important findings about the relationship between smoking and cervical disc replacement outcomes:

Reoperation Risk

• Smokers had a significantly higher reoperation rate: 15.8% versus 1.2% for non-smokers
• Reoperations were related to loosening or migration of the artificial disc device
• The study concluded that tobacco use was associated with an increased risk of reoperation, likely from reduced implant stability

Where Results Were Similar

• No significant differences between smokers and non-smokers in spinal alignment on imaging
• No significant differences in patient-reported outcome scores — how patients rated their pain and function
• Smokers showed greater measured segmental range of motion in this cohort; that radiographic finding should not be treated as proof of better function

The study concluded that while disc replacement preserved function in smokers, tobacco use was associated with an increased risk of reoperation — likely from reduced implant stability — and that surgeons should monitor smokers closely after surgery.

Important: These findings come from a single-institution study of 102 patients. Individual results vary. This summary is for educational purposes and does not replace individualized medical advice. Your specific situation, anatomy, and overall health all factor into what outcomes you can expect.

What This Means for Patients

This research provides useful information for anyone considering cervical disc replacement — and it points toward several practical takeaways:

The study identifies an association, not a cessation effect

The nonsmoker group had a lower observed reoperation rate, but the study did not randomize tobacco exposure, test a quitting program, or determine how long a patient should stop before surgery. It cannot quantify how cessation changes an individual’s risk.

Smoking is one of several factors your surgeon weighs — not a reason to hide it

This study does not mean that patients who smoke cannot have cervical disc replacement. It means that smoking is one variable among many — including your anatomy, the severity of your neck problem, your overall health, and your goals — that your surgeon should know about. Being open about smoking lets your surgeon factor it into your plan and discuss strategies to lower your risk.

Cervical disc replacement can still be an appropriate motion-preserving option

The study found no statistically significant group difference in the reported pain and disability measures. That does not prove equivalence, and it does not cancel the observed reoperation difference.

The appropriate discussion is individualized: what the study found, what it did not test, how smoking status relates to the proposed procedure, and what alternatives are reasonable.

Read the Original Article

The PubMed record for the peer-reviewed study includes the citation, author list, and abstract.

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About Dr. Marc Greenberg, MD

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Cervical Disc Replacement vs. Fusion (ACDF)

Minimally Invasive Lumbar Fusion Recovery: What to Expect

Cervical Disc Replacement Procedure

Minimally Invasive Spine Surgery

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