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In a Swedish study, smokers (up to 14 cigarettes a day), were 46% more likely to have spinal surgery as compared to people who never smoked
However, those products were specifically developed to help people quit smoking and had to prove they could do so in clinical trials before getting FDA approval, just like any other drug that makes a therapeutic claim
Inhalation Toxicology 18(14):10711076
Models were adjusted for potentially confounding variables, chosen a priori based on known associations with outcomes of interest: age, sex, race, weight status, glomerular diagnosis, UPC, log eGFR, and steroid use