Electrical Stimulation to Enhance Spinal Fusion: A Systematic Review
28. Februar 2014
12. Mai 2014
24. September 2014 (online)
Study Design Systematic review.
Clinical Questions Compared with no stimulation, does electrical stimulation promote bone fusion after lumbar spinal fusion procedures? Does the effect differ based on the type of electrical stimulation used?
Methods Electronic databases and reference lists of key articles were searched up to October 15, 2013, to identify randomized controlled trials (RCTs) comparing the effect of electrical stimulation to no electrical stimulation on fusion rates after lumbar spinal fusion for the treatment of degenerative disease. Two independent reviewers assessed the strength of evidence using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria.
Results Six RCTs met the inclusion criteria. The following types of electrical stimulation were investigated: direct current (three studies), pulsed electromagnetic field (three studies), and capacitive coupling (one study). The control groups consisted of no stimulation (two studies) or placebo (four studies). Marked heterogeneity in study populations, characteristics, and design prevented a meta-analysis. Regardless of the type of electrical stimulation used, cumulative incidences of fusion varied widely across the RCTs, ranging from 35.4 to 90.6% in the intervention groups and from 33.3 to 81.9% in the control groups across 9 to 24 months of follow-up. Similarly, when stratified by the type of electrical stimulation used, fusion outcomes from individual studies varied, leading to inconsistent and conflicting results.
Conclusion Given the inconsistency in study results, possibly due to heterogeneity in study populations/characteristics and quality, we are unable to conclude that electrical stimulation results in better fusion outcomes compared with no stimulation. The overall strength of evidence for the conclusions is low.
Keywordselectrical stimulation - direct current - pulsed electromagnetic field - capacitive coupling - fusion - lumbar spine
- 1 Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine (Phila Pa 1976) 2004; 29 (7) 726-733 , discussion 733–734
- 2 Nandyala SV, Marquez-Lara A, Fineberg SJ, Pelton M, Singh K. Prospective, randomized, controlled trial of silicate-substituted calcium phosphate versus rhBMP-2 in a minimally invasive transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 2014; 39 (3) 185-191
- 3 Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine (Phila Pa 1976) 2007; 32 (3) 382-387
- 4 Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am 2003; 85-A (1) 1-3
- 5 Methods Guide for Effectiveness and Comparative Effectiveness Reviews. AHRQ Publication No. 10(12)-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2012. Available at: www.effectivehealthcare.ahrq.gov
- 6 West S, King V, Carey TS , et al. Systems to Rate the Strength of Scientific Evidence. Evidence Report/Technology Assessment No. 47 (Prepared by the Research Triangle Institute-University of North Carolina Evidence-based Practice Center, Contract No. 290–97–0011). Rockville, MD: Agency for Healthcare Research and Quality; 2002
- 7 Atkins D, Best D, Briss PA , et al; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004; 328 (7454) 1490
- 8 Andersen T, Christensen FB, Egund N , et al. The effect of electrical stimulation on lumbar spinal fusion in older patients: a randomized, controlled, multi-center trial: part 2: fusion rates. Spine (Phila Pa 1976) 2009; 34 (21) 2248-2253
- 9 Jenis LG, An HS, Stein R, Young B. Prospective comparison of the effect of direct current electrical stimulation and pulsed electromagnetic fields on instrumented posterolateral lumbar arthrodesis. J Spinal Disord 2000; 13 (4) 290-296
- 10 Kane WJ. Direct current electrical bone growth stimulation for spinal fusion. Spine (Phila Pa 1976) 1988; 13 (3) 363-365
- 11 Linovitz RJ, Pathria M, Bernhardt M , et al. Combined magnetic fields accelerate and increase spine fusion: a double-blind, randomized, placebo controlled study. Spine (Phila Pa 1976) 2002; 27 (13) 1383-1389 , discussion 1389
- 12 Mooney V. A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions. Spine (Phila Pa 1976) 1990; 15 (7) 708-712
- 13 Goodwin CB, Brighton CT, Guyer RD, Johnson JR, Light KI, Yuan HA. A double-blind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions. Spine (Phila Pa 1976) 1999; 24 (13) 1349-1356 , discussion 1357
- 14 Resnick DK, Choudhri TF, Dailey AT , et al; American Association of Neurological Surgeons/Congress of Neurological Surgeons. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 17: bone growth stimulators and lumbar fusion. J Neurosurg Spine 2005; 2 (6) 737-740