The literature reports that the rate of secondary surgery in patients undergoing posterior lumbar decompression surgery is approximately 15% at 5 years postoperatively. The results were published in a recent issue of J Neurosurg Spine. The study included all cases of initial single-, double-, or multi-segment bilateral lumbar laminectomy, and excluded cases of fusion, simple laminectomy, discectomy, or complete laminectomy. The study criteria included age, comorbidities (including coronary heart disease, diabetes, hypertension, osteoporosis, obesity, smoking, chronic obstructive pulmonary disease, and depression), and postoperative clinical symptoms (including low back pain, radicular symptoms, lower extremity sensorimotor disorders, intermittent claudication, and gastrointestinal bladder dysfunction). The results showed that a total of 500 patients met the inclusion criteria, and the average follow-up time for all cases was 46.8 months. 81 patients (16.2%) required secondary surgery due to postoperative spine-related diseases, and 72 patients (88.9%) required secondary surgery due to postoperative progressive spinal degeneration among the 81 patients. The other 9 patients required secondary surgery for non-degenerative reasons (including hematoma, incisional infection, and incisional dehiscence). Multifactorial logistic regression analysis concluded that smoking was an independent risk factor for increasing the risk of secondary surgery. Smoking remained an independent risk factor for secondary surgery in both the single-segment and multisegment groups. Analysis of 72 patients who required secondary surgery for progressive spinal degeneration showed that smoking was a statistically significant independent factor that increased the risk of secondary surgery. In the 9 patients who underwent secondary surgery for non-degenerative reasons, chronic obstructive pulmonary disease was a statistically significant independent factor that increased the risk of secondary surgery. In conclusion, smoking is a risk factor for secondary surgery in patients who have undergone single- or multisegmental laminectomy and in patients with progressive postoperative spinal degeneration. This finding should serve as a cautionary tale for clinicians, and it is hoped that they will pay special attention to counseling patients to quit smoking in their clinical practice.