Vaping FAQs

does vaping hurt your spine

by Jordane O'Connell Published 2 years ago Updated 1 year ago
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Finally, smoking and vaping can also lead to spine instability. Because the spinal discs degenerate when using these products, the spine is vulnerable to abnormal motions. Nicotine vaping can also degenerate tendons, ligaments, and muscles, further destabilizing the spine.

Finally, smoking and vaping can also lead to spine instability. Because the spinal discs degenerate when using these products, the spine is vulnerable to abnormal motions. Nicotine vaping can also degenerate tendons, ligaments, and muscles, further destabilizing the spine.Oct 4, 2021

Full Answer

Does smoking or vaping cause pain?

The more one smokes or vapes, the slower the flow of oxygen-rich blood throughout the body. Cleveland Clinic suggests that consumption of nicotine will worsen pain over time, particularly in places where blood has difficulty reaching. It is possible, too, to feel pain while quitting.

Why does my vape hurt my chest?

Change it up. There could be various reasons for chest pain from vaping. Excessive heat, high nicotine, or maybe even the specific flavorings in a particular e-liquid could be the cause. Some users on vaping forums have stated that (fiery) cinnamon liquids containing the flavoring chemical cinnamaldehyde give them chest pain.

Can vaping cause dizziness?

If you’re concerned about dizziness or the feeling of being lightheaded, the best course of action is to lower your nicotine or the amount you vape in short periods. If you’d prefer to not lower your consumption, it’s something that will likely go away as your body gets accustomed to nicotine.

What does it feel like to vape?

Similar to the feeling of smoking for the first time, it’s not uncommon to experience lightheadedness and dizziness from vaping. Also similar to smoking, this typically will stop presenting itself the more you consume. This feeling is not from vaping in general though; it’s from vaping nicotine—particularly with high nicotine.

What are the physiological effects of smoking e-cigarettes?

What is the strongest link to e-cigarettes?

Can vaping affect spinal fusion?

Does vaping cause inflammation?

Is e-cigarette smoke a carcinogen?

Is e-cigarettes healthier than conventional cigarettes?

Do e-cigarettes affect spinal surgery?

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What are the physiological effects of smoking e-cigarettes?

Primary research suggests that the principle mechanism behind physiological consequences related to e-cigarette exposure is oxidative stress and inflammation. Oxidative stress and inflammation are intricately linked bidirectional processes that together lead to cellular and tissue damage [13]. E-cigarette vapor itself, like cigarette smoke, is a potent source of ROS [14]. When using an e-cigarette, ROS are directly inhaled into the lungs and play an integral role in stimulating inflammatory signaling cascades [14,15]. Moreover, inflammation stemming from exposure to toxic chemicals in e-cigarette vapor results in the recruitment of immune cells like macrophages and the release of pro-inflammatory cytokines. Subsequently, inflammatory proteins and immune cells generate ROS that work in a feed-forward manner to increase inflammation and cellular damage, which can have widespread effects on various organ systems.

What is the strongest link to e-cigarettes?

According to the Centers for Disease Control and Prevention (CDC), vitamin E acetate , a common additive in e-cigarette devices, represents the strongest link to e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak [5].

Can vaping affect spinal fusion?

The outcome and results of spinal fusion operations in patients who admit to e-cigarettes use are poorly described in the literature. A 2019 review by Amaro et al. provided a review of available knowledge on the effects of vaping on orthopedic surgeries that are pertinent to spinal fusions [30]. While the effects of e-cigarettes use on spinal fusion is not well documented, experiments of posterolateral spinal fusions in the rabbit model demonstrate that nicotine alone can affect surgical outcomes [30]. A 1995 study by Silcox et al. demonstrated systemic nicotine significantly increased pseudoarthrosis rate to 100% compared to 44% in control animals in a rabbit model of posterolateral spine fusion [31]. A 2000 study by Theiss et al. revealed nicotine alone inhibits the expression of multiple cytokines with a variety of functions during spine fusion [32].

Does vaping cause inflammation?

Recent data by Crotty Alexander et al. suggests that e-cigarette exposure triggers an inflammatory response that results in cellular damage to the airways, specifically by disrupting pulmonary epithelial barrier function [10]. In a feed-forward manner , disruption of barrier function and continued exposure to chemical toxins found in e-cigarette vapor contributes to systemic inflammation that can result in downstream organ pathologies such as renal fibrosis [10]. An essential component of inflammation is oxidative stress. Oxidative stress, which is generated by increased levels of reactive oxygen species (ROS), can activate the transcription of inflammatory genes such as IL-8, a potent chemokine that recruits leukocytes and is involved in chronic inflammation [11]. Several groups have clearly demonstrated the link between vaping and oxidative stress using both in vivo and in vitro laboratory models. Lerner et al. measured intracellular glutathione (GSH) levels in mice exposed to e-cigarette vapor for three days (five hours total exposure time) [11]. GSH is an essential endogenous antioxidant that maintains cellular redox balance by responding to ROS stress [11]. The authors found that there was a significant decrease in GSH levels in mice exposed to e-cigarette vapor compared with air-exposed controls (P < 0.05) [11]. Additionally, there were modulations in the balance between the reduced and oxidized forms of GSH in mice exposed to e-cigarette vapor [11]. Ganapathy et al. found that human epithelial bronchial cells exposed to e-cigarette vapor for two weeks in vitro had significantly increased levels of oxidative damage, indicated by 8-oxo-dG DNA lesions, compared to the control group of air-only (P < 0.05) [12]. Cells exposed to e-cigarette vapor showed significantly increased levels of oxidative damage compared to cells exposed only to cigarette smoke (P < 0.05) [12]. Moreover, the authors reported a significant decrease in total antioxidant capacity in cells exposed to either e-cig vapor or cigarette smoke (P < 0.05), with no significant difference between the two experimental groups [12].

Is e-cigarette smoke a carcinogen?

The general consensus is that e-cigarette vapor has substantially lower levels of carcinogens and toxins found in traditional cigarette smoke. For example, Tayyarah et al. report that cigarette smoke contains between 3069 and 3350 μg/puff of the 55 harmful and potentially harmful constituents (HPHC) measured in the study [6]. Conversely, e-cigarette vapor contained <2 μg/puff of HPHCs, or ~99% less analytes than cigarettes [6]. However, there are novel toxicology risks associated with e-cigarettes that must be further evaluated. E-cigarettes have heating coils that are made of various metallic compounds and can be used with thousands of different e-liquids with various chemical flavoring additives [7]. Williams et al. quantified the abundance of metallic elements in various e-liquids using induced coupled plasma-optical emissions spectroscopy (ICP-OES) [8]. The authors reported that e-cigarette vapor contained aerosol particles >1µm of tin, silver, iron, nickel, aluminum, silicate [8]. Strikingly, nine of the 11 metals detected in e-cigarette vapor were equal to or greater than the concentration detected in cigarette smoke [8]. All of these metals are associated with human toxicity at high doses, particularly in the nervous, renal, and respiratory systems [8].

Is e-cigarettes healthier than conventional cigarettes?

According to a recent study of U.S. adults, 95% of those interviewed believed e-cigarettes to be “cleaner and healthier” than conventional products, suggesting the validity of introductory claims were widely accepted by the general public [3].

Do e-cigarettes affect spinal surgery?

Additionally, studies exploring the effects of e-cigarettes on spinal surgery outcomes, such as spinal fusions, are sparse in the literature. Further prospective research studies with a focus on the variety of e-cigarette chemical toxins and flavoring agents is needed to assess the impact on spinal health.

How does smoking affect your sensitivity to pain?

Sensitivity to Pain. Smoking increases sensitivity to pain by altering the perception of pain through the neuroendocrine system. Smokers who have spinal symptoms for the same amount of time as non-smokers report symptoms as more severe and present for a greater percentage of time each day.

How much disc recovery does smoking cause?

In cellular studies, stopping nicotine exposure demonstrated only 75-85 percent disc recovery in “ light smoking” and 55-75 percent disc recovery in “heavy smoking” groups at one year. And while quitting smoking has been linked to improved back pain, restoration of the nicotine-degenerated disc is minimal.

Does nicotine cause disc degeneration?

Studies indicate that nicotine decreases the disc’s ability to regenerate its injured cells. Additionally, nicotine decreases blood flow and blocks oxygen transport to the disc (which already has minimal blood supply). This starves the disc of nutrients leading to disc degeneration. Disc degeneration may be an independent cause ...

Does nicotine damage the disc?

A normal disc is composed of a central “jelly-like” portion called the nucleus and outer rings of fibers called the annulus. Nicotine damages both the annulus and nucleus of the intervertebral disc. It appears that a normal disc, under normal wear and tear, develops small injuries called fissures, and these continually repair themselves. Studies indicate that nicotine decreases the disc’s ability to regenerate its injured cells. Additionally, nicotine decreases blood flow and blocks oxygen transport to the disc (which already has minimal blood supply). This starves the disc of nutrients leading to disc degeneration. Disc degeneration may be an independent cause of pain and instability of the spine. Therefore, smokers damage healthy discs and accelerate damage to already degenerating discs. In cellular studies, stopping nicotine exposure demonstrated only 75-85 percent disc recovery in “light smoking” and 55-75 percent disc recovery in “heavy smoking” groups at one year. And while quitting smoking has been linked to improved back pain, restoration of the nicotine-degenerated disc is minimal.

Does smoking cause osteoporosis?

Nicotine affects hormone levels, vitamin D and calcium absorption, blood vessel constriction and bone oxygen supply. In fact, nicotine opposes estrogen and stimulates earlier menopause in women. Smoking lowers testosterone levels. It also instigates chronic inflammation. Through these effects, nicotine promotes osteoporosis or weakening of bones. This increases the rate of fractures both in the spine and throughout the body. Women smoking more than one pack per day throughout adulthood have an average of five to ten percent lower bone density than non-smokers. Even second-hand smoke affects bone mineral density. Smoking causes an increased lifetime risk of developing a spine fracture by 32 percent in men and 13 percent in women.

Does nicotine cause spine problems?

Although less significant than cancer, nicotine use has been linked to spine problems on multiple levels. Absolutely no level of nicotine negates these risks, and therefore the only way to avoid this is complete cessation of nicotine-containing substances.

Is nicotine a carcinogen?

Nicotine in cigarettes, e-cigarettes, vapes, oral tobacco and even nicotine patches all contain carcinogenic substances such as hydrocarbons and tobacco-specific nitrosamines (TSNA). Nicotine use is the most preventable form of cancer and death known to mankind. Although less significant than cancer, nicotine use has been linked to spine problems ...

What is a vape cartridge?

Vape cartridges, like traditional cigarettes, contain nicotine. Combined with other chemicals and artificial flavors, the nicotine is heated and inhaled as a vapor. Like with regular cigarettes, the act of vaping releases dopamine into the system which produces a good feeling – that satisfaction as highlighted in cigarette marketing in the past.

Does nicotine make you feel pain?

Cleveland Clinic suggests that consumption of nicotine will worsen pain over time, particularly in places where blood has difficulty reaching. It is possible, too, to feel pain while quitting. It’s a sensation that can improve, however, by replacing smoking habits with healthier activities. At Bon Secours Virginia Orthopaedic & Spine Specialists, ...

Does vaping cause joint pain?

The Connection Between Vaping and Joint Pain. If you smoke, and want to quit, any day is a great to begin. Whether you have smoked regularly for a short time or for years, completing a full day without a cigarette offers healthful benefits to your body. You lower the risk for heart attack, and your oxygen levels significantly improve.

Does vaping cause blood to flow slower?

Initially, a person who vapes may feel a brief respite from discomfort, but over time vaping can lead to bigger problems. The more one smokes or vapes, the slower the flow of oxygen-rich blood throughout the body.

Is vaping safer than smoking?

(Source: Truth Initiative) While some view vaping as less harmful than smoking, it doesn’t necessarily mean vaping is risk-free, especially where joint pain is concerned.

How long should you smoke before a spine surgery?

If you smoke, your spine surgeon may recommend you quit four to six weeks before your surgery, and remain nicotine free for four weeks thereafter. This can reduce your risk of wound complications by 50%. 1

How does smoking affect your heart?

The effects of smoking tobacco can begin with administration of general anesthesia, which is commonly used for spine surgery. First, nicotine increases heart rate, meaning your heart is pumping more and working harder. Blood pressure may increase and because nicotine is a vasoconstrictor, blood vessels narrow. People who smoke produce more mucus that may affect the airway and complicate breathing while under anesthesia. Additional medication (eg, albuterol, a bronchodilator) may be needed to increase oxygen intake.

What is an e-cigarette?

Electronic cigarettes or e-cigarettes are also known as electronic nicotine delivery systems or ENDS. These battery-powered devices are designed to resemble traditional tobacco products (eg, cigarettes, pipes), although some of these products look like a pen or memory stick. An e-cigarette delivers nicotine in a heated flavored vapor.

Does smoking cause bone fractures?

Furthermore, smoking interferes with the body’s ability to absorb calcium and more quickly breaks down estrogen—both of which are vital to healthy bones. Fact: Osteoporosis is a contributing risk factor to painful vertebral compression fractures.

Is it safe to smoke e-cigarettes?

Therefore, the question as to whether e-cigarettes are safer than smoking tobacco remains unanswered.

Does tobacco affect spinal fusion?

However, tobacco use increases the risk for an incomplete fusion, failed fusion, or non-union.

Does smoking cause wounds to heal?

Furthermore, it can take longer for surgical wounds to heal. This can happen because smokers have more carbon monoxide in their bodies that steals the oxygen needed to expedite healing of tissues.

How does smoking affect spinal fusion?

Smoking affects the body’s ability to heal by causing ischemia (insufficient blood flow) at the cellular level. This affects the ability of a fusion to heal and create solid bone between vertebral bodies. As a result of this, we ask our elective spinal patients to stop smoking prior to surgery as it is in their best interest.

Why is smoking bad for your back?

Smoking remains an important issue when it comes to back pain and spinal surgery. Smoking affects circulation of blood in the small vessels. Blood carries oxygen and nutrients to cells. This is important because there is little circulation to the the shock-absorbing discs that cushion our spine.

How long after spinal fusion can you smoke?

I recommend that patients who plan to have spinal surgery give up smoking for about 6 weeks after surgery. This includes e-cigarettes until more information about their effects are known.

Can you stop nicotine before spinal surgery?

Anything that continues to provide nicotine to the system should be discontinued prior to elective spinal surgery. Particularly, if there are no indications that surgery or neural (nerve) decompression is urgent. Praveen V. Mummaneni, MD — Neurosurgeon/Todd Vogel, MD — Neurosurgeon. Yes.

Does nicotine cause vasoconstriction?

I believe the working hypothesis is nicotine causes vasoconstriction. Vasoconstriction affects soft tissues by decreasing blood flow and increasing the risk for infection. During fusion, a healthy blood flow is essential to the formation of new bone. Vasoconstriction stunts the development of new bone and may result in failure of the fusion process. In the absence of clear spinal instability or the need for neural (nerve) decompression, I prefer not to operate on elective surgical patients who smoke. This being said, smoking is the most difficult addiction to fight. Of course, there are exceptions to every rule. Smokers need to be educated about the risks they take and the reduced improvement in outcomes associated with smoking.

Does smoking reduce blood flow?

Cigarette smoking further reduces blood flow, meaning blood flow to the discs is less.The same problem affects wound healing after surgery. Smokers have a higher risk of wound problems, including infections. In addition to the blood flow issue, nicotine in cigarettes inhibits bone healing.

Can you use nicotine patches for fusion surgery?

Nicotine is the culprit, so nicotine patches and gums are to be avoided if fusion surgery is to be performed. I suggest patients talk to their primary care physician. Options, such as Chantix, hypnosis, acupuncture, and even laser therapy are used. Often smokers need to try to stop smoking many times in order to succeed.

Why does vaping hurt?

There could be various reasons for chest pain from vaping. Excessive heat, high nicotine, or maybe even the specific flavorings in a particular e-liquid could be the cause.

What are the side effects of vaping?

Coughing. Headaches. Dizziness or headrush. Weight loss/gain. Nausea. Tired and fatigued. Chest pain from vaping. Although vapes are not medical devices, side effects for the user may occur. But these side effects are not a given.

How to stop dizziness when vaping?

If you’re concerned about dizziness or the feeling of being lightheaded, the best course of action is to lower your nicotine or the amount you vape in short periods. If you’d prefer to not lower your consumption, it’s something that will likely go away as your body gets accustomed to nicotine.

What to do if you have chest pains when vaping?

Then maybe you can lower the power, reduce your nicotine, change your atom izer or coil , or change your flavor . Essentially, try and change your entire set up if you have to.

Does nicotine cause headaches?

Alkaloids have a physiological effect on the user, and cessation from habitual usage may cause headaches. Nicotine is the major alkaloid in tobacco, accounting for about 95% of the alkaloid content, but there are other tobacco minor alkaloids in tobacco smoke, not present in e-liquid.

Can vaping cause dizziness?

Dizziness or headrush. Similar to the feeling of smoking for the first time, it’s not uncommon to experience lightheadedness and dizziness from vaping. Also similar to smoking, this typically will stop presenting itself the more you consume.

Can you get a sore throat from vaping?

Some coils used in vaping are nickel-based, and it’s not uncommon for users to discover they have an allergy to nickel. Also, several reports online can be found associating a sore throat with high nicotine, especially when used with high levels of propylene glycol (50% or more).

Can inhalation motion cause diaphragm to strain?

Are you doing lung hits with restricted airflow. That inhalation motion (in high frequency) could strain your diaphragm if you are pulling really hard

Is back pain a serious issue?

See a doctor!! Back pain can be a very serious issue. Don't just assume any correlation.

Does vaping salt cause back pain?

If you're vaping salt nicotine then I would agree that the back pain are related since the nicotine concentracion is almost 5 to 6 times higher than the normal freebase juice. I tested stopping for a few weeks, and the back pain stopped. It was very noticeable for me since my back pains were nasty pains. I started up once again and after just a day the pains came back in the same way. Good reason to stop right? Lol

Frankie Super Member ECF Veteran

When you stop nicotine, various types of pain subside, as you get more blood everywhere and the healing processes are not supressed by vasoconstricted blood vessels. But I felt so miserable it took almost a month before I realised the pain was gone...

Frankie Super Member ECF Veteran

If you were not a user before I do not think nicotine will be a real help agaist stress and/or anxiety. I mean, it is a stimulant. Just the opposite to what one really needs when stressed or anxious. Anyway, if you were/are not addicted, I strongly believe you should just try different ways of dealing with these things.

Angela Ultra Member ECF Veteran

I had no idea nicotine could cause this type of problem. I think we get much more nicotine when vaping than we know. I was using the lowest strength juice, but it is still much more than when smoking a cigarette I think. Anyhow, the pain is causing me stress, so it sort of defeats the purpose for me. I was not smoking cigs when I began vaping.

planetofthevapes Super Member ECF Veteran

I agree with Angela, try 0mg juice if you ever decide to use e-cigs instead of regular cigs again.

Frankie Super Member ECF Veteran

Have you already stopped vaping? I would really like to know if people suffer withdrawal when they return to nicotine in other form than smoking and then quit again. I mean it would be heaven to be able to have a miligram or two once in a while and not suffer the quit again.

boxhead Super Member Verified Member ECF Veteran

i was at my doc yesterday and he knew about my e-cig and asked hows my not smoking? with a laugh, so i took out my SD and took a drag puffing out vapor saying i have not had a analog for two months.

boxhead Super Member Verified Member ECF Veteran

ya i pee about every 15 minuets, getting afraid i`ll drop mye-cig in the bowl. so i have neck strap for the SD hehehe.

What are the physiological effects of smoking e-cigarettes?

Primary research suggests that the principle mechanism behind physiological consequences related to e-cigarette exposure is oxidative stress and inflammation. Oxidative stress and inflammation are intricately linked bidirectional processes that together lead to cellular and tissue damage [13]. E-cigarette vapor itself, like cigarette smoke, is a potent source of ROS [14]. When using an e-cigarette, ROS are directly inhaled into the lungs and play an integral role in stimulating inflammatory signaling cascades [14,15]. Moreover, inflammation stemming from exposure to toxic chemicals in e-cigarette vapor results in the recruitment of immune cells like macrophages and the release of pro-inflammatory cytokines. Subsequently, inflammatory proteins and immune cells generate ROS that work in a feed-forward manner to increase inflammation and cellular damage, which can have widespread effects on various organ systems.

What is the strongest link to e-cigarettes?

According to the Centers for Disease Control and Prevention (CDC), vitamin E acetate , a common additive in e-cigarette devices, represents the strongest link to e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak [5].

Can vaping affect spinal fusion?

The outcome and results of spinal fusion operations in patients who admit to e-cigarettes use are poorly described in the literature. A 2019 review by Amaro et al. provided a review of available knowledge on the effects of vaping on orthopedic surgeries that are pertinent to spinal fusions [30]. While the effects of e-cigarettes use on spinal fusion is not well documented, experiments of posterolateral spinal fusions in the rabbit model demonstrate that nicotine alone can affect surgical outcomes [30]. A 1995 study by Silcox et al. demonstrated systemic nicotine significantly increased pseudoarthrosis rate to 100% compared to 44% in control animals in a rabbit model of posterolateral spine fusion [31]. A 2000 study by Theiss et al. revealed nicotine alone inhibits the expression of multiple cytokines with a variety of functions during spine fusion [32].

Does vaping cause inflammation?

Recent data by Crotty Alexander et al. suggests that e-cigarette exposure triggers an inflammatory response that results in cellular damage to the airways, specifically by disrupting pulmonary epithelial barrier function [10]. In a feed-forward manner , disruption of barrier function and continued exposure to chemical toxins found in e-cigarette vapor contributes to systemic inflammation that can result in downstream organ pathologies such as renal fibrosis [10]. An essential component of inflammation is oxidative stress. Oxidative stress, which is generated by increased levels of reactive oxygen species (ROS), can activate the transcription of inflammatory genes such as IL-8, a potent chemokine that recruits leukocytes and is involved in chronic inflammation [11]. Several groups have clearly demonstrated the link between vaping and oxidative stress using both in vivo and in vitro laboratory models. Lerner et al. measured intracellular glutathione (GSH) levels in mice exposed to e-cigarette vapor for three days (five hours total exposure time) [11]. GSH is an essential endogenous antioxidant that maintains cellular redox balance by responding to ROS stress [11]. The authors found that there was a significant decrease in GSH levels in mice exposed to e-cigarette vapor compared with air-exposed controls (P < 0.05) [11]. Additionally, there were modulations in the balance between the reduced and oxidized forms of GSH in mice exposed to e-cigarette vapor [11]. Ganapathy et al. found that human epithelial bronchial cells exposed to e-cigarette vapor for two weeks in vitro had significantly increased levels of oxidative damage, indicated by 8-oxo-dG DNA lesions, compared to the control group of air-only (P < 0.05) [12]. Cells exposed to e-cigarette vapor showed significantly increased levels of oxidative damage compared to cells exposed only to cigarette smoke (P < 0.05) [12]. Moreover, the authors reported a significant decrease in total antioxidant capacity in cells exposed to either e-cig vapor or cigarette smoke (P < 0.05), with no significant difference between the two experimental groups [12].

Is e-cigarette smoke a carcinogen?

The general consensus is that e-cigarette vapor has substantially lower levels of carcinogens and toxins found in traditional cigarette smoke. For example, Tayyarah et al. report that cigarette smoke contains between 3069 and 3350 μg/puff of the 55 harmful and potentially harmful constituents (HPHC) measured in the study [6]. Conversely, e-cigarette vapor contained <2 μg/puff of HPHCs, or ~99% less analytes than cigarettes [6]. However, there are novel toxicology risks associated with e-cigarettes that must be further evaluated. E-cigarettes have heating coils that are made of various metallic compounds and can be used with thousands of different e-liquids with various chemical flavoring additives [7]. Williams et al. quantified the abundance of metallic elements in various e-liquids using induced coupled plasma-optical emissions spectroscopy (ICP-OES) [8]. The authors reported that e-cigarette vapor contained aerosol particles >1µm of tin, silver, iron, nickel, aluminum, silicate [8]. Strikingly, nine of the 11 metals detected in e-cigarette vapor were equal to or greater than the concentration detected in cigarette smoke [8]. All of these metals are associated with human toxicity at high doses, particularly in the nervous, renal, and respiratory systems [8].

Is e-cigarettes healthier than conventional cigarettes?

According to a recent study of U.S. adults, 95% of those interviewed believed e-cigarettes to be “cleaner and healthier” than conventional products, suggesting the validity of introductory claims were widely accepted by the general public [3].

Do e-cigarettes affect spinal surgery?

Additionally, studies exploring the effects of e-cigarettes on spinal surgery outcomes, such as spinal fusions, are sparse in the literature. Further prospective research studies with a focus on the variety of e-cigarette chemical toxins and flavoring agents is needed to assess the impact on spinal health.

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