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Darryl Lau, Mitchel S. Berger, Dhruv Khullar and John Maa

higher subsidence rates in the placement of carbon fiber cages following anterior cervical discectomy and fusion. 7 The mechanism behind poor fusion and greater rates of subsidence in smokers is related to poor bone quality secondary to tobacco smoking. Nicotine exposure is associated with delayed vascularization and smaller areas of revascularization, which lead to reduced levels of osteogenesis and hypocellular fusion mass. 19 There is also evidence that smokers have higher rates of recurrent lumbar disc herniation after surgery. 16 , 43 , 92 The higher rates of