Non-Tobacco Nicotine Is Associated With Increased Complications Following Posterior Cervical Fusion: A Retrospective Cohort Study

Study Design Retrospective cohort study. Objectives To examine the impact of non-tobacco nicotine (NTN) dependence on pseudarthrosis and postoperative complications following posterior cervical fusion (PCF). Methods 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. Results A total of 7102 patients were included. At 3 years, NTND patients had higher rates of pseudarthrosis (2.51% vs 1.84%, P = 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 ( P < 0.05) except DVT. Compared to controls, TD patients had higher rates of all postoperative complications at 3 months and 3 years, except pseudarthrosis ( P < 0.05). Compared to TD patients, NTND patients had higher rates of cervical fracture and pneumonia at 3 months ( P < 0.05), and higher rates of cervical fracture at 3 years ( P < 0.05). At 3 months, the NTND cohort demonstrated lower rates of opioid abuse/dependence, readmission, and emergency service use ( P < 0.05). Conclusions 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. Level of Evidence III.