The effect of electrical stimulation therapies on spinal fusion: a cross-disciplinary systematic review and meta-analysis of the preclinical and clinical data
- PMID: 31593923
- DOI: 10.3171/2019.5.SPINE19465
The effect of electrical stimulation therapies on spinal fusion: a cross-disciplinary systematic review and meta-analysis of the preclinical and clinical data
Abstract
Objective: Nonunion is a common complication of spinal fusion surgeries. Electrical stimulation technologies (ESTs)-namely, direct current stimulation (DCS), capacitive coupling stimulation (CCS), and inductive coupling stimulation (ICS)-have been suggested to improve fusion rates. However, the evidence to support their use is based solely on small trials. Here, the authors report the results of meta-analyses of the preclinical and clinical data from the literature to provide estimates of the overall effect of these therapies at large and in subgroups.
Methods: A systematic review of the English-language literature was performed using PubMed, Embase, and Web of Science databases. The query of these databases was designed to include all preclinical and clinical studies examining ESTs for spinal fusion. The primary endpoint was the fusion rate at the last follow-up. Meta-analyses were performed using a Freeman-Tukey double arcsine transformation followed by random-effects modeling.
Results: A total of 33 articles (17 preclinical, 16 clinical) were identified, of which 11 preclinical studies (257 animals) and 13 clinical studies (2144 patients) were included in the meta-analysis. Among preclinical studies, the mean fusion rates were higher among EST-treated animals (OR 4.79, p < 0.001). Clinical studies similarly showed ESTs to increase fusion rates (OR 2.26, p < 0.001). Of EST modalities, only DCS improved fusion rates in both preclinical (OR 5.64, p < 0.001) and clinical (OR 2.13, p = 0.03) populations; ICS improved fusion in clinical studies only (OR 2.45, p = 0.014). CCS was not effective at increasing fusion, although only one clinical study was identified. A subanalysis of the clinical studies found that ESTs increased fusion rates in the following populations: patients with difficult-to-fuse spines, those who smoke, and those who underwent multilevel fusions.
Conclusions: The authors found that electrical stimulation devices may produce clinically significant increases in arthrodesis rates among patients undergoing spinal fusion. They also found that the pro-arthrodesis effects seen in preclinical studies are also found in clinical populations, suggesting that findings in animal studies are translatable. Additional research is needed to analyze the cost-effectiveness of these devices.
Keywords: electrical stimulation; nonunion; pseudarthrosis; spinal fusion; surgical technique.
Similar articles
-
Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217. Cochrane Database Syst Rev. 2022. PMID: 36321557 Free PMC article.
-
Noninvasive electrical stimulation as an adjunct to fusion procedures: a systematic review and meta-analysis.J Neurosurg Spine. 2022 Jan 28;37(1):137-148. doi: 10.3171/2021.11.SPINE211098. Print 2022 Jul 1. J Neurosurg Spine. 2022. PMID: 35090134 Review.
-
The effect of bioactive glasses on spinal fusion: A cross-disciplinary systematic review and meta-analysis of the preclinical and clinical data.J Clin Neurosci. 2020 Aug;78:34-46. doi: 10.1016/j.jocn.2020.04.035. Epub 2020 Apr 21. J Clin Neurosci. 2020. PMID: 32331941
-
Electrical stimulation to enhance spinal fusion: a systematic review.Evid Based Spine Care J. 2014 Oct;5(2):87-94. doi: 10.1055/s-0034-1386752. Evid Based Spine Care J. 2014. PMID: 25278882 Free PMC article. Review.
-
Efficacy of electrical stimulation for spinal fusion: a meta-analysis of fusion rate.Spine J. 2013 Oct;13(10):1238-43. doi: 10.1016/j.spinee.2013.06.056. Epub 2013 Aug 28. Spine J. 2013. PMID: 23993034
Cited by
-
Role of biophysical stimulation in multimodal management of vertebral compression fractures.Comput Struct Biotechnol J. 2023 Nov 14;21:5650-5661. doi: 10.1016/j.csbj.2023.11.023. eCollection 2023. Comput Struct Biotechnol J. 2023. PMID: 38047233 Free PMC article. Review.
-
Evaluation of instrumentation and pedicle screw design for posterior lumbar fixation: A pre-clinical in vivo/ex vivo ovine model.JOR Spine. 2023 Jan 13;6(2):e1245. doi: 10.1002/jsp2.1245. eCollection 2023 Jun. JOR Spine. 2023. PMID: 37361331 Free PMC article.
-
Creation and preclinical evaluation of a novel mussel-inspired, biomimetic, bioactive bone graft scaffold: direct comparison with Infuse bone graft using a rat model of spinal fusion.J Neurosurg Spine. 2023 Mar 31;39(1):113-121. doi: 10.3171/2023.2.SPINE22936. Print 2023 Jul 1. J Neurosurg Spine. 2023. PMID: 37021767 Free PMC article.
-
Electroactive Spinal Instrumentation for Targeted Osteogenesis and Spine Fusion: A Computational Study.Int J Spine Surg. 2023 Feb;17(1):95-102. doi: 10.14444/8389. Epub 2023 Jan 25. Int J Spine Surg. 2023. PMID: 36697205 Free PMC article.
-
Design considerations for piezocomposite materials for electrical stimulation in medical implants.J Med Eng Technol. 2022 Jul;46(5):402-414. doi: 10.1080/03091902.2022.2080881. Epub 2022 Jun 8. J Med Eng Technol. 2022. PMID: 35674706 Free PMC article.
Publication types
LinkOut - more resources
Full Text Sources
Research Materials