Medical Student The Ohio State University College of Medicine Columbus, Ohio, United States
Introduction: Many clinicians associate nicotine as the causative agent in the negative and deleterious effects of smoking on bone growth and spine fusion. However, this relationship is unclear, and nicotine has demonstrated dose dependent trophic effects on bone growth and osteoblast proliferation. While nicotine is the primary driver of physiologic addiction in smoking, isolated and controlled use of nicotine is the one of the most effective adjuncts to quitting smoking. If nicotine has limited impact on bone health, the utilization of nicotine screening and abstinence may negatively impact the ability of clinicians to aid patients who are trying to quit smoking in the setting of spine surgery.
Methods: 1005 papers were identified, of which 501 studies were excluded, leaving 504 studies available for review. Studies were stratified based upon exclusion criteria (i.e. full text availability and language). Of note, 52 studies were deemed to be irrelevant. 452 studies remained for eligibility assessment. Of the 452 remaining, 218 failed to assess study outcomes, 169 failed to assess bone biology, 13 assessed five patients or fewer, and 12 were deemed to be ineligible of the study criteria. 40 studies remained for inclusion within this systematic review.
Results: Of the 40 papers identified for inclusion within the study, 30 papers were classified as “Animal Basic Science” while the remaining 10 were categorized as “Human Basic Science.” Of the 40 papers, 11 noted decreased cell proliferation and boney growth, while eight showed an increase. Four papers noted an increase in gene expression products, while eleven noted a significant decrease.
Conclusion : The results of this study demonstrate nicotine has a variety of complex interactions on osteoblast and osteoclastic activity. Nicotine demonstrates dose dependent effects on osteoblast proliferation, boney growth, and gene expression. Further study is warranted to extrapolate the effects of solitary nicotine on clinical outcomes.
