title: Direct current stimulation for spine fusion in a nicotine exposure model.
abstract: BACKGROUND
  Decreased effectiveness in spinal fusion procedures in patients who smoke before, during, or after the operation has been noted in several clinical studies. In previous work, direct current (DC) electrical stimulation has been shown to enhance inter-transverse process fusion in a rabbit model.
  
  
  OBJECTIVE
  To test the efficacy of DC stimulation on bone healing in spinal fusion in rabbits exposed to nicotine.
  
  
  METHODS
  A randomized and controlled interventional study.
  
  
  METHODS
  Thirty male New Zealand white rabbits received a single level posterolateral, inter-transverse process fusion with autologous iliac crest bone. One group (control) acted as a control without nicotine or electrical stimulation. A second group (Nic) received a continuous dose of nicotine via a transdermal patch to simulate a heavy smoker, and a third group, nicotine/stimulator group (Nic/Stim), additionally received a 100-microamp DC stimulator. The fusion masses (L5-L6) and the adjacent unfused control segment (L4-L5) were evaluated radiographically, manually, and biomechanically.
  
  
  RESULTS
  The Nic group showed significantly higher fusion rate compared with the control group. The Nic/Stim group also demonstrated significantly higher fusion rate and X-ray trabeculation compared with the control group. However, the Nic/Stim group was not significantly higher than the Nic group in fusion rate or X-ray trabeculation.
  
  
  CONCLUSIONS
  Nicotine significantly improved fusion rate compared with controls, and DC stimulation significantly increased X-ray trabeculation of nicotine treated rabbits compared with controls.
authors.affiliation: Department of Orthopaedics, Musculoskeletal Research Center, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506-9196, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: France
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Norman
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Buchanan
authors.forename: Michael
authors.initials: M
authors.lastname: Scheel
authors.forename: Michael
authors.initials: M
authors.lastname: Veale
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Ackerman
authors.forename: Nina B
authors.initials: NB
authors.lastname: Clovis
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Kish
authors.forename: Bruce
authors.initials: B
authors.lastname: Simon
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000379:methods; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004558:Electric Stimulation; D008297:Male; D009538:Nicotine / Q000494:pharmacology*; D011336:Probability; D011817:Rabbits; D011897:Random Allocation; D016059:Range of Motion, Articular / Q000502:physiology; D012016:Reference Values; D012680:Sensitivity and Specificity; D013122:Spinal Diseases / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods*; D014184:Transplantation, Homologous
chemical_list: D009538:Nicotine