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

Abstract

This study was a meta-analysis to examine whether electrical stimulation has a specific effect on spinal fusion. Little evidence exists on the efficacy of electrical stimulation for improving fusion rate of spinal fusion surgery. Using MEDLINE (1966-2000) and EMBASE (1985-1999), a search for articles was carried out using the Medical Subject Headings: (1) electric stimulation or electromagnetic fields, (2) spinal fusion, (3) controlled or clinical trial, and (4) human. Data were extracted from all the hit articles and additionally collected from appropriate journal lists. A total of five randomized controlled trials (RCT) on bones assessing healing of spinal fusion were identified and scored on methodological quality. All the identified studies reported positive findings, but the quality score of each trial showed wide flaws. Because of relatively homogenous subjects who had spine fusion and radiographic assessment from these studies, pooling of the data was able to be performed. Excluding one trial with the lowest score, the combined results of four trials, whose major endpoints were the success rate of the fusion, revealed a statistically significant effect of electrical stimulation with various techniques, but the selected trials still showed wide variation in view of stimulation modalities and treatment protocol. The pooled result of the studies in this review revealed the efficacy of electrical stimulation based on proved methodological quality. As problems on therapeutic modality and protocol remain, there is a further need for improvement in design to constitute acceptable proof and to establish treatment programs that better demonstrate electrical stimulation effects on spinal fusion.

Bioelectricity and microcurrent therapy for tissue healing – a narrative review

“…Results for methodologically sound controlled trials consistently indicate statistically significant outcomes in favour of DC MCT compared with control groups. 86 It is particularly effective when used in high risk cases such as those with previous failed fusions, multiple level surgery, smokers and those with co-morbidities such as diabetes and obesity, [87][88][89] and has a stronger favourable evidence base than either capacitative or inductive coupling, particularly for posterior fusions. 90 An economic evaluation of the therapy as an adjunct in spinal fusion surgery 91 also found that it provided significant cost savings and shorter inpatient stays.…”

“…71,86,88,90,[100][101][102][103][104][105] Meta-analyses have been weakened by pooling data from trials using heterogeneous groups and treatment parameters, and even different forms of electrotherapy. 86,101 Nevertheless, consideration of the evidence regarding MCT in particular suggests that its application, usually for several months, may enhance tissue healing in a variety of bone lesions.…”

The Biologic Effects and the Therapeutic Mechanism of Action of Electric and Electromagnetic Field Stimulation on Bone and Cartilage: New Findings and a Review of Earlier Work

“…Numerous authors have reported remarkable success in treating these chronic conditions, [16][17][18][19] stress fractures, 20 osteotomies, [21][22] spinal fusions, [23][24][25] and acquired and congenital pseudoarthroses 26 with various forms of electrical stimulation. Unfortunately, the heterogeneity of trial design,…”

Pulsed Magnetic Field Therapy Increases Tensile Strength in a Rat Achilles’ Tendon Repair Model

“…A more rapid healing phase allows for earlier mobilization, which could decrease the incidence of adhesions at the repair site. Although pulsed electromagnetic fields (PMFs) have shown clinical value in the adjunctive treatment of fractures, spinal fusions, and chronic wounds, [2][3][4][5] surprisingly few, sometimes conflicting, studies of the effect of PMFs on tendon or ligament repair have been reported. 6 -9 In a manner similar to bone and wound repair, tendon repair involves an inflammatory phase, angiogenesis, cell proliferation, collagen production, and remodeling stages, whether the tendon is located in an epitenon or in a synovial sheath.…”