Combined Magnetic Fields Accelerate and Increase Spine Fusion

Linovitz, Raymond; Pathria, Mini N.; Bernhardt, Mark; Green, Daniel; Law, Melvin D; McGuire, Robert A.; Montesano, Pasquale X.; Rechtine, Glen; Salib, Richard M.; Ryaby, James T.; Faden, Joel S; Ponder, Regina; Muenz, Larry R.; Magee, Frank P.; Garfin, Steven A

doi:10.1097/00007632-200207010-00002

Cited by 108 publications

(25 citation statements)

References 20 publications

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“…Three studies compared DC stimulation to no stimulation,8 9 10 with only one study using a placebo device (i.e., an inactive stimulator) in the control group; three compared PEMF stimulation to no stimulation,9 11 12 with two employing placebo devices, and one study compared CC to no stimulation using placebo devices 13. Marked heterogeneity was present across the studies (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Electrical Stimulation to Enhance Spinal Fusion: A Systematic Review

Park

Lau

Brodt

et al. 2014

Evidence-Based Spine-Care Journal

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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.

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Section: Resultsmentioning

confidence: 99%

Electrical Stimulation to Enhance Spinal Fusion: A Systematic Review

Park

Lau

Brodt

et al. 2014

Evidence-Based Spine-Care Journal

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“…35 Studies using simple static radiography, 2,3,23 dynamic radiography, 36 computed tomography, 23,30 and clinical criteria, in particular the complaint of pain, 2 were found in the literature. In addition to the variety of methods, the interpretation of the results is occasionally subjective and has low reproducibility.…”

Section: Effect Of Pulsed Electromagnetic Field On the Consolidation mentioning

confidence: 99%

“…In animal models, increased mineral bone density, 51 increased bone stiffness, 22,52 and more rapid incorporation of bone grafts were observed with the use of PEMF, but no significant improvement was found in the final consolidation rate. 21,23 In a prospective, double-blind, randomized clinical study, Mooney 50 observed a bone consolidation rate of 92% in interbody lumbar arthrodesis surgeries with the use of PEMF versus 65% in the control group. Bose 3 found a consolidation rate of 97.9% after posterolateral lumbar arthrodesis, but the study was performed without a control group.…”

Section: Effect Of Pulsed Electromagnetic Field On the Consolidation mentioning

confidence: 99%

“…This technique is non-invasive and non-radioactive and shows no evidence of causing cell damage. 2,23 There is a lack of studies in the literature evaluating the effect of the pulsed electromagnetic field on lumbar posterolateral arthrodesis, and there are no controlled studies in this specific group of patients. In addition, existing studies evaluating the consolidation of lumbar arthrodeses have used diverse and poorly reproducible methods to access the consolidation status of arthrodeses, without adequate periodicity to interpret the evolution of the consolidation process.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Pulsed Electromagnetic Field on the Consolidation of Posterolateral Arthrodeses in the Lumbosacral Spine: A Prospective, Double-Blind, Randomized Study

et al. 2017

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Objective: To assess the effect of pulsed electromagnetic field (PEMF) on the consolidation of instrumented lumbar posterolateral arthrodeses in patients who have been surgically treated for degenerative spine disease. Methods: Forty cases were recruited from 163 consecutive patients undergoing lumbar arthrodesis at the same center. The patients were randomized into two groups of 20 patients: Active Group, who were exposed to PEMF for 4 hours a day for 90 days after surgery, and Inactive Group, who received an identical device, with the same instructions for use but without the ability to generate PEMF. The patients underwent computed tomography scans at 45, 90, 180 and 360 days after surgery to check for the occurrence of arthrodesis at each operated spinal level. Results: In the course of the study, two patients were excluded from each group. There were no significant differences between the groups with respect to age, gender, smoking habit, or the number of vertebral levels included in the arthrodesis. The percentage of consolidation of the vertebral levels increased at 90, 180 and 360 days compared to 45 days (p<0.001) in both groups. The Active Group had a 276% greater chance of consolidation in the vertebral levels (OR = 3.76; 95% CI: 1.39-10.20), regardless of the time of evaluation. Patients in the Active Group presented 16% more consolidation than patients in the inactive group (p=0.018). Conclusions: Post-operative exposure to PEMF following instrumented arthrodesis of the lumbar spine for degenerative spine disease increased consolidation in the first year after surgery.Keywords: Randomized controlled trials as topic; Spinal fusion; Spine; Electromagnetic fields; Arthrodesis. (OR = 3,76; IC 95%: 1,20) RESUMO Objetivo: Avaliar o efeito do campo eletromagnético pulsado (CEMP) na consolidação de artrodeses posterolaterais lombares instrumentadas em pacientes que foram tratados cirurgicamente de doença degenerativa da coluna vertebral. Métodos: Quarenta casos foram recrutados de 163 pacientes consecutivos submetidos à artrodese lombar no mesmo centro. Os pacientes foram randomizados em dois grupos de 20 pacientes: Grupo Ativo, que foi exposto a CEMP por 4 horas por dia durante 90 dias após a cirurgia e Grupo Inativo, que recebeu um dispositivo idêntico, com as mesmas instruções de uso, mas sem a capacidade de gerar CEMP. Os pacientes foram submetidos a exames de tomografia computadorizada aos 45, 90, 180 e 360 dias após a cirurgia para verificar a ocorrência de artrodese em cada nível espinhal operado. Resultados: No decorrer do estudo, dois pacientes foram excluídos de cada grupo. Não houve diferenças significativas entre os grupos com relação à idade, sexo, tabagismo ou número de níveis vertebrais incluídos na artrodese. A percentagem de consolidação dos níveis vertebrais aumentou aos 90, 180 e 360 dias em comparação com 45 dias (p < 0,001) em ambos os grupos. O Grupo Ativo teve uma chance de consolidação 276% maior nos níveis vertebrais

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“…Generation and accurate control of such fields within the human body is a relatively easy matter and is routinely done for diagnostic purposes [16], with fields as high as several Tesla commonly being employed. Furthermore, application of a static magnetic field has already been proposed [17,18] as a means of stimulating bone growth, although the effects are not yet entirely clear and the bio-chemical mechanisms involved remain to be fully identified. In the present paper, the novel suggestion is put forward that bone growth could be stimulated in vivo via a magnetomechanical mechanism involving the transmission of stresses and strains to growing bone via small local deflections within a porous ferromagnetic material, induced by the application of a magnetic field.…”

Section: Introductionmentioning

confidence: 99%