Efficacy of electrical stimulation for spinal fusion: a meta-analysis of fusion rate

2013 ◽  
Vol 13 (10) ◽  
pp. 1238-1243 ◽  
Author(s):  
Nai F. Tian ◽  
Yao S. Wu ◽  
Xiao L. Zhang ◽  
Fang M. Mao ◽  
Hua Z. Xu ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Spinal Fusion ◽  
Meta Analysis ◽  
Fusion Rate

scholarly journals Postoperative bisphosphonate do not significantly alter the fusion rate after lumbar spinal fusion: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jun Mei ◽  
Xiaoxu Song ◽  
Xiaoming Guan ◽  
Dou Wu ◽  
Junjie Wang ◽  
...  
Keyword(s):  
Bone Formation ◽  
Spinal Fusion ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Lumbar Spinal Fusion ◽  
Fusion Surgery ◽  
Number Of Patients ◽  
Cage Subsidence ◽  
Lumbar Spinal

Abstract Background To evaluate the effect of postoperative BP treatment on improving the fusion rate after lumbar spinal fusion surgery by performing a meta-analysis of randomized controlled trials (RCTs) and other comparative cohort studies. Methods A comprehensive search of PubMed, EMBASE, the Web of Science, and the Cochrane Central Register of Controlled Trials was performed for RCTs and other comparative cohort studies on the effect of BP treatment on improving the fusion rate after lumbar spinal fusion surgery. The primary outcome measures were the number of patients with bone formation grades A, B, and C at 12 months of follow-up; fusion rates at 12 and 24 months of follow-up; vertebral compression fracture (VCF) at 12 and 24 months of follow-up; pedicle screw loosening at 24 months of follow-up; and cage subsidence, the Oswestry disability index (ODI), and the visual analogue score (VAS) at 12 months of follow-up. The final search was performed in July 2020. Results Seven studies with 401 patients were included. Compared with the placebo, BP treatment did not significantly alter the number of patients with bone formation grades A, B, and C, or the VAS at the 12-month follow-up or the fusion rates at the 12- and 24-month follow-ups. In addition, compared with the placebo, BPs significantly reduced the risks of VCF at the 12- and 24-month follow-ups, pedicle screw loosening at the 24-month follow-up, and cage subsidence and the ODI at the 12-month follow-up. Conclusions Postoperative BPs do not clearly improve bone formation and the fusion rate, but they reduce VCF, cage subsidence, and loosening of pedicle screws after lumbar fusion surgery compared with the control treatment.

scholarly journals The use of electrical stimulation to enhance spinal fusion

2002 ◽  
Vol 13 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Michael A. Morone ◽  
Henry Feuer
Keyword(s):  
Electrical Stimulation ◽  
Spinal Fusion ◽  
Healing Process ◽  
Experimental Studies ◽  
Spinal Instrumentation ◽  
Fusion Rate ◽  
Beneficial Effects ◽  
Osseous Union ◽  
Spinal Segments ◽  
Spinal Arthrodesis

The goal of spinal arthrodesis is a solid osseous union across one or more spinal segments. A solid bone union after arthrodesis is commonly known as a spinal fusion. Surgeons have begun to understand the biomechanical and biological factors that influence the bone-healing process. One of the most commonly used adjuncts is spinal instrumentation. Instrumentation has increased the spinal fusion rate; however, fusion failure (that is, nonunion or pseudarthrosis) remains significant. A less commonly used adjunct is electrical stimulation (ES). Investigators in experimental studies have demonstrated the beneficial effects of ES on increasing the fusion rate. In this review the authors discuss the evidence concerning the benefits of ES as an adjunct to spinal arthrodesis. In addition, the different types of ES devices are described along with the current experimental and clinical evidence for each type of device.

scholarly journals Direct Current Electrical Stimulation Increases the Fusion Rate of Spinal Fusion Cages

Spine ◽  
2000 ◽  
Vol 25 (20) ◽  
pp. 2580-2587 ◽  
Author(s):  
Jeffrey M. Toth ◽  
Howard B. Seim ◽  
Jeffrey D. Schwardt ◽  
Wendy B. Humphrey ◽  
Joel A. Wallskog ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Spinal Fusion ◽  
Direct Current ◽  
Fusion Rate

scholarly journals Exploratory meta-analysis on dose-related efficacy and morbidity of bone morphogenetic protein in spinal arthrodesis surgery

2016 ◽  
Vol 24 (3) ◽  
pp. 457-475 ◽  
Author(s):  
Christoph P. Hofstetter ◽  
Anna S. Hofer ◽  
Allan D. Levi
Keyword(s):  
Spinal Fusion ◽  
Bone Morphogenetic Protein ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Control Group ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Morphogenetic Protein ◽  
Spinal Arthrodesis

OBJECT Bone morphogenetic protein (BMP) is frequently used for spinal arthrodesis procedures in an “off-label” fashion. Whereas complications related to BMP usage are well recognized, the role of dosage is less clear. The objective of this meta-analysis was to assess dose-dependent effectiveness (i.e., bone fusion) and morbidity of BMP used in common spinal arthrodesis procedures. A quantitative exploratory meta-analysis was conducted on studies reporting fusion and complication rates following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF) supplemented with BMP. METHODS A literature search was performed to identify studies on BMP in spinal fusion procedures reporting fusion and/or complication rates. From the included studies, a database for each spinal fusion procedure, including patient demographic information, dose of BMP per level, and data regarding fusion rate and complication rates, was created. The incidence of fusion and complication rates was calculated and analyzed as a function of BMP dose. The methodological quality of all included studies was assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were analyzed using a random-effects model. Event rates are shown as percentages, with a 95% CI. RESULTS Forty-eight articles met the inclusion criteria: ACDF (n = 7), PCF (n = 6), ALIF (n = 9), TLIF/PLIF (n = 17), and PLF (n = 9), resulting in a total of 5890 patients. In ACDF, the lowest BMP concentration analyzed (0.2–0.6 mg/level) resulted in a fusion rate similar to the highest dose (1.1–2.1 mg/level), while permitting complication rates comparable to ACDF performed without BMP. The addition of BMP to multilevel constructs significantly (p < 0.001) increased the fusion rate (98.4% [CI 95.4%–99.4%]) versus the control group fusion rate (85.8% [CI 77.4%–91.4%]). Studies on PCF were of poor quality and suggest that BMP doses of ≤ 2.1 mg/level resulted in similar fusion rates as higher doses. Use of BMP in ALIF increased fusion rates from 79.1% (CI 57.6%–91.3%) in the control cohort to 96.9% (CI 92.3%–98.8%) in the BMP-treated group (p < 0.01). The rate of complications showed a positive correlation with the BMP dose used. Use of BMP in TLIF had only a minimal impact on fusion rates (95.0% [CI 92.8%–96.5%] vs 93.0% [CI 78.1%–98.0%] in control patients). In PLF, use of ≥ 8.5 mg BMP per level led to a significant increase of fusion rate (95.2%; CI 90.1%–97.8%) compared with the control group (75.3%; CI 64.1%–84.0%, p < 0.001). BMP did not alter the rate of complications when used in PLF. CONCLUSIONS The BMP doses used for various spinal arthrodesis procedures differed greatly between studies. This study provides BMP dosing recommendations for the most common spine procedures.

Electrical stimulation as an adjunct to spinal fusion: A meta-analysis of controlled clinical trials

2002 ◽  
Vol 23 (7) ◽  
pp. 496-504 ◽  
Author(s):  
Masami Akai ◽  
Noritaka Kawashima ◽  
Toshitaka Kimura ◽  
Kunihiko Hayashi
Keyword(s):  
Clinical Trials ◽  
Electrical Stimulation ◽  
Spinal Fusion ◽  
Meta Analysis ◽  
Controlled Clinical Trials

scholarly journals The effect of electrical stimulation therapies on spinal fusion: a cross-disciplinary systematic review and meta-analysis of the preclinical and clinical data

2020 ◽  
Vol 32 (1) ◽  
pp. 106-126 ◽  
Author(s):  
Ethan Cottrill ◽  
Zach Pennington ◽  
A. Karim Ahmed ◽  
Daniel Lubelski ◽  
Matthew L. Goodwin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electrical Stimulation ◽  
Spinal Fusion ◽  
Clinical Data ◽  
Clinical Studies ◽  
English Language ◽  
Meta Analysis ◽  
Capacitive Coupling ◽  
Preclinical Studies ◽  
Meta Analyses

OBJECTIVENonunion 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.METHODSA 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.RESULTSA 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.CONCLUSIONSThe 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.

scholarly journals Efficacy of Electrical Stimulation for Spinal Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shakib Akhter ◽  
Abdul Rehman Qureshi ◽  
Idris Aleem ◽  
Hussein Ali El-Khechen ◽  
Shadman Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electrical Stimulation ◽  
Randomized Controlled Trials ◽  
Spinal Fusion ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals The effect of platelet-rich plasma on the fusion rate and clinical outcome of spinal fusion surgery: A systematic review and meta-analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243204
Author(s):  
Ying-feng Cai ◽  
Tian-Zhao Tian ◽  
Li-Ye Chen ◽  
Bao-Xin Liu ◽  
Jian-Peng Zhou ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cohort Studies ◽  
Spinal Fusion ◽  
Complication Rate ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Clinical Results ◽  
Fusion Rate ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

Background Platelet-rich plasma (PRP) is widely used in many orthopedic surgeries and spinal disease treatments; however, the effect of PRP on spinal fusion remains controversial. Questions/Purposes To assess the fusion rate and clinical results of PRP compared with non-PRP administration in the treatment of spinal fusion with regard to decreasing pain and improving healing and function. Patients and methods Studies comparing PRP to non-PRP treatment with respect to the fusion rate and clinical outcome in patients who underwent spinal fusion surgery were included. Result Three randomized controlled trials (RCTs) and 7 prospective cohort studies were identified. The spinal fusion rate was not significantly different between the groups in all RCTs or cohort studies at the final follow-up. In comparison, PRP significantly reduced pain after surgery as evaluated in the RCT analysis and the complication rate did not differ significantly between the two groups. Conclusion According to the available studies, PRP does not contribute to the union rate, relieve pain or increase the complication rate in spinal fusion surgery. As clinical heterogeneity exists in these studies, further large, well-designed RCTs that focus on the standard assessment of PRP are needed.

scholarly journals Postoperative Bisphosphonate Do Not Significantly Alter The Fusion Rate After Lumbar Spinal Fusion: A Meta-Analysis

2021 ◽  
Author(s):  
Jun Mei ◽  
Xiaoxu Song ◽  
Xiaoming Guan ◽  
Dou Wu ◽  
Junjie Wang ◽  
...  
Keyword(s):  
Bone Formation ◽  
Spinal Fusion ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Lumbar Spinal Fusion ◽  
Fusion Surgery ◽  
Number Of Patients ◽  
Cage Subsidence ◽  
Lumbar Spinal

Abstract BACKGROUND: To evaluate the effect of postoperative BP treatment on improving the fusion rate after lumbar spinal fusion surgery by performing a meta-analysis of randomized controlled trials (RCTs) and other comparative cohort studies.METHODS: A comprehensive search of PubMed, EMBASE, the Web of Science and the Cochrane Central Register of Controlled Trials was performed for RCTs and other comparative cohort studies on the effect of BP treatment on improving the fusion rate after lumbar spinal fusion surgery. The primary outcome measures were the number of patients with bone formation grades A, B, and C at 12 months of follow-up, fusion rates at 12 and 24 months of follow-up, vertebral compression fracture (VCF) at 12 and 24 months of follow-up, pedicle screw loosening at 24 months follow-up, cage subsidence, the Oswestry Disability Index (ODI) and the visual analogue score (VAS) at 12 months of follow-up. The final search was performed in July 2020.RESULTS: Seven studies with 401 patients were included. Compared with the placebo, BP treatment did not significantly alter the number of patients with bone formation grades A, B and C, or the VAS at the 12-month follow-up or the fusion rates at the 12- and 24-month follow-ups. In addition, compared with the placebo, BPs significantly reduced the risks of VCF at the 12- and 24-month follow-ups, pedicle screw loosening at the 24-month follow-up, and cage subsidence and the ODI at the 12-month follow-up.CONCLUSIONS: Postoperative BPs do not clearly improve bone formation and the fusion rate, but they reduce VCF, cage subsidence and loosening of pedicle screws after lumbar fusion surgery compared with the control treatment.

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