title: Reversing the inhibitory effect of nicotine on spinal fusion using an osteoinductive protein extract.
abstract: METHODS
  The effect on spinal fusion of an osteoinductive bone protein extract in the presence of a known inhibitor of spinal fusion (systemic nicotine) was studied prospectively in an animal model of posterolateral lumbar fusion.
  
  
  OBJECTIVE
  To evaluate the ability of a bovine-derived osteoinductive bone protein extract to overcome the inhibitory effect of nicotine in a rabbit spine fusion model.
  
  
  BACKGROUND
  Multiple studies have demonstrated the ability of a variety of osteoinductive growth factors to serve as a bone graft substitute for lumbar spinal fusion under "normal" healing conditions.
  
  
  METHODS
  Forty-eight adult female New Zealand white rabbits underwent spine arthrodesis at L5-L6 while receiving systemic nicotine through a subcutaneous miniosmotic pump. Arthrodesis was performed using one of the following three graft materials: 1) autogenous iliac crest, 2) osteoinductive bone protein delivered in an allogeneic demineralized bone matrix/ collagen carrier, or 3) osteoinductive bone protein delivered with autogenous iliac crest. Fusions were assessed by blinded manual palpation, radiography, and biomechanical testing.
  
  
  RESULTS
  Of the 44 rabbits manually tested by blinded observers, all 14 in the osteoinductive bone protein plus autogenous iliac crest bone group had solid fusions (14 of 14), whereas the fusion rate was less in the osteoinductive bone protein plus demineralized bone matrix group (nine of 14, 64%; P = 0.02), and there were no fusions in the autogenous iliac crest only group (0 of 16, 0%; P = 0.000001). The use of osteoinductive bone protein with autogenous bone produced stronger and stiffer fusions compared with those using autogenous bone alone or osteoinductive bone protein with allograft bone.
  
  
  CONCLUSIONS
  Cigarette smoking and nicotine are inhibitory factors in the healing of fractures and spine fusions. This study shows that the inhibitory effect of nicotine can be overcome with an osteoinductive bone growth factor in an animal model.
authors.affiliation: Emory Spine Center, Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Silcox
authors.forename: S D
authors.initials: SD
authors.lastname: Boden
authors.forename: J H
authors.initials: JH
authors.lastname: Schimandle
authors.forename: P
authors.initials: P
authors.lastname: Johnson
authors.forename: T E
authors.initials: TE
authors.lastname: Whitesides
authors.forename: W C
authors.initials: WC
authors.lastname: Hutton
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D001857:Bone Matrix / Q000637:transplantation; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation; D002417:Cattle; D003094:Collagen / Q000627:therapeutic use; D004195:Disease Models, Animal; D004337:Drug Carriers; D005260:Female; D007085:Ilium / Q000637:transplantation; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009538:Nicotine / Q000037:antagonists & inhibitors / Q000633:toxicity*; D018722:Nicotinic Agonists / Q000633:toxicity*; D011542:Pseudarthrosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D011817:Rabbits; D011859:Radiography; D013123:Spinal Fusion
chemical_list: D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D004337:Drug Carriers; D018722:Nicotinic Agonists; D009538:Nicotine; D003094:Collagen