In the Journals

Two types of electrical stimulation therapy may enhance spinal fusion

A systematic review and meta-analysis found electrical stimulation therapies significantly increased spinal fusion rates in patients, according to a published study.

“Although prior reviews have described the effects of electrical stimulation therapies on spinal fusion, none to date have systematically evaluated both the preclinical and clinical literature of all three available technologies,” Ethan Cottrill, MS, a PhD candidate at The Johns Hopkins University School of Medicine, and colleagues wrote.

Researchers gathered preclinical and clinical studies through PubMed, Embase and Web of Science databases. Studies that met the inclusion criteria were chosen to gain more information on the type of electrical stimulation therapies (EST) used, specifications of the EST, means of determining interbody fusion and the overall fusion rate at final follow-up. The results of direct current stimulation (DCS), capacitive coupling stimulation (CCS) and inductive coupling stimulation (ICS) in these articles were evaluated.

Findings presented from 13 clinical studies showed the DCS and ICS EST modalities increased the fusion rates of patients. In the six clinical studies evaluating the efficacy of DCS, the fusion rate ranged from 35% to 96% in treated patients and ranged from 33% to 86% in controls. At final follow-up, patients treated with DCS had a significantly higher fusion rate than control patients. In the six clinical studies evaluating the efficacy of ICS, fusion rates ranged from 63% to 98% for treated patients and ranged from 49% to 87% for the control group. Patients who received ICS had significant overall improvements in fusion rates. CCS did not show an increase in fusion rates.

“We were surprised by how large an effect ESTs appear to have on spine fusion. DCS and ICS technologies appear to significantly enhance fusion rates,” Cottrill told Healio.com/Orthopedics in an interview. “Interestingly, CCS devices, despite theoretical similarities to DCS and ICS devices, were not found to enhance fusion rates with statistical significance. Additional research on CCS devices may yield different results.”

According to the study, ESTs can be beneficial in helping fuse patients’ spines especially in patients with difficult-to-fuse spines, those who smoke and those who undergo multilevel fusions.

“Our meta-analysis suggest that ESTs produce clinically significant increases in spinal fusion rates, including in patients with known risk factors for nonunion,” Cottrill said. “However, additional research is needed to evaluate the cost-effectiveness of these devices. Patients should talk to their surgeons about whether these devices may be right for them.” by Erin T. Welsh

 

Disclosures: Cottrill reports non-study-related grant support from the National Institute on Aging. Please see the study for all the other authors’ relevant financial disclosures.

A systematic review and meta-analysis found electrical stimulation therapies significantly increased spinal fusion rates in patients, according to a published study.

“Although prior reviews have described the effects of electrical stimulation therapies on spinal fusion, none to date have systematically evaluated both the preclinical and clinical literature of all three available technologies,” Ethan Cottrill, MS, a PhD candidate at The Johns Hopkins University School of Medicine, and colleagues wrote.

Researchers gathered preclinical and clinical studies through PubMed, Embase and Web of Science databases. Studies that met the inclusion criteria were chosen to gain more information on the type of electrical stimulation therapies (EST) used, specifications of the EST, means of determining interbody fusion and the overall fusion rate at final follow-up. The results of direct current stimulation (DCS), capacitive coupling stimulation (CCS) and inductive coupling stimulation (ICS) in these articles were evaluated.

Findings presented from 13 clinical studies showed the DCS and ICS EST modalities increased the fusion rates of patients. In the six clinical studies evaluating the efficacy of DCS, the fusion rate ranged from 35% to 96% in treated patients and ranged from 33% to 86% in controls. At final follow-up, patients treated with DCS had a significantly higher fusion rate than control patients. In the six clinical studies evaluating the efficacy of ICS, fusion rates ranged from 63% to 98% for treated patients and ranged from 49% to 87% for the control group. Patients who received ICS had significant overall improvements in fusion rates. CCS did not show an increase in fusion rates.

“We were surprised by how large an effect ESTs appear to have on spine fusion. DCS and ICS technologies appear to significantly enhance fusion rates,” Cottrill told Healio.com/Orthopedics in an interview. “Interestingly, CCS devices, despite theoretical similarities to DCS and ICS devices, were not found to enhance fusion rates with statistical significance. Additional research on CCS devices may yield different results.”

According to the study, ESTs can be beneficial in helping fuse patients’ spines especially in patients with difficult-to-fuse spines, those who smoke and those who undergo multilevel fusions.

“Our meta-analysis suggest that ESTs produce clinically significant increases in spinal fusion rates, including in patients with known risk factors for nonunion,” Cottrill said. “However, additional research is needed to evaluate the cost-effectiveness of these devices. Patients should talk to their surgeons about whether these devices may be right for them.” by Erin T. Welsh

 

Disclosures: Cottrill reports non-study-related grant support from the National Institute on Aging. Please see the study for all the other authors’ relevant financial disclosures.