Nicotine and Spinal Fusion:

The animal model established a direct relationship between the development of a nonunion in the presence of systemic nicotine.  The results suggested that bone formed in the face of systemic nicotine may have inferior biomechanic properties.

This study establishes a direct relationship between the development of a nonunion in the systemic presence of nicotine in an animal model.

The 100% nonunion rate in the nicotine group was a dramatic result.  The nonunions in the nicotine animals did not result from systemic toxicity as they ate, drank and behaved normally.  If the ultimate effect of nicotine was to delay rather than prevent spine fusion, we may have found some fused spines if the rabbits were permitted to live longer. Nevertheless, nicotine clearly inhibited the incorporation of autologous bone graft into a spine fusion mass.

Nonunion of spine fusions is an enormous clinical problem with no easy solution.  A nonunion may require several additional surgeries, often with poor outcomes.

Because tobacco products contain nicotine, it is justifiable to insist that patients stop smoking or using tobacco products before undergoing spinal fusion.  These results question the use of nicotine patches during the perioperative period.