• Maxwell D Gruber, David Gibbs, Joshua Vignolles-Jeong, Stephanus Viljoen, Andrew J Grossbach, and David Xu.
• Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
• Neurosurgery. 2023 Aug 1; 93 (2): 247256247-256.

BackgroundMany clinicians associate nicotine as the causative agent in the negative and deleterious effects of smoking on bone growth and spine fusion. Although nicotine is the primary driver of physiological addiction in smoking, isolated and controlled use of nicotine is one of the most effective adjuncts to quitting smoking.ObjectiveTo explore the relationship between nicotine and noncombustion cigarette products on bone growth.MethodsOne thousand five studies were identified, of which 501 studies were excluded, leaving 504 studies available for review. Of note, 52 studies were deemed to be irrelevant. Four hundred fifty-two studies remained for eligibility assessment. Of the remaining 452, 218 failed to assess study outcomes, 169 failed to assess bone biology, 13 assessed 5 patients or fewer, and 12 were deemed to be ineligible of the study criteria. Forty studies remained for inclusion within this systematic review.ResultsOf the 40 studies identified for inclusion within the study, 30 studies were classified as "Animal Basic Science," whereas the remaining 10 were categorized as "Human Basic Science." Of the 40 studies, 11 noted decreased cell proliferation and boney growth, whereas 8 showed an increase. Four studies noted an increase in gene expression products, whereas 11 noted a significant decrease.ConclusionThe results of this study demonstrate that nicotine has a variety of complex interactions on osteoblast and osteoclastic activities. 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.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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