Electrically Induced Osteogenesis: Relationship between Charge, Current Density, and the Amount of Bone Formed

Ct, Brighton; Zb, Friedenberg; Black, Jonathan; Jl, Esterhai; Je, Mitchell; Montique, F

doi:10.1097/00003086-198111000-00015

Cited by 69 publications

(33 citation statements)

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“…In an in vitro study, Okihana and Shimomura [1988] reported the devitalization of cells with DC over 10 mA; however, in this study with rabbits, there was no devitalization at the cellular level. The currents used in this study are similar to those described previously in a rabbit tibia model in which a 1-cm stainless steel cathode was placed in the medullary canal [Brighton et al, 1981]. In that study, bone formation around the cathode was optimal at 20 mA, but tissue necrosis occurred at higher currents up to 50 mA.…”

Section: Discussionmentioning

confidence: 62%

Electrical stimulation of the growth plate: A potential approach to an epiphysiodesis

Dodge¹,

Bowen²,

Oh³

et al. 2007

Bioelectromagnetics

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Epiphysiodesis is an operative procedure that induces bony bridges to form across a growth plate of a bone to stop longitudinal growth. This is a very common orthopedic procedure to correct disproportional long-bone growth discrepancies; however, present techniques require an operation and anesthesia. Our study was designed to develop a minimally invasive method of epiphysiodesis by using electrical stimulation with DC current. In a rabbit model, a thin titanium electrode was inserted into a single location of the distal femoral growth plate in three groups: one without current (control), one group with a constant 10 microA (low current, LC), and one group with a 50 microA (high current, HC). The current was delivered for 2 weeks. The nontreated femur served as a control for each animal. Femur lengths were measured and comparisons were made between operated (left) and nonoperated (right) femurs. Digitized histomorphometric and volumetric analyses were performed on each growth plate, and detailed assessments were made of any morphological changes. Using length measurements, the difference in femur length was significantly larger in the HC group and not in the LC or control groups, showing bone growth inhibition at the higher current. In the HC group, bony bridges and disorganized growth plates were observed. This study shows that delivery of an electrical current of 50 microA for as little as 2 weeks can markedly affect bone growth as evidenced by changes in epiphyseal plate volume and architectural organization, and the study supports the use of this minimally invasive approach as a potential method of achieving an epiphysiodesis.

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Section: Discussionmentioning

confidence: 62%

Electrical stimulation of the growth plate: A potential approach to an epiphysiodesis

Dodge¹,

Bowen²,

Oh³

et al. 2007

Bioelectromagnetics

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“…8 Direct current (DC) has appeared to be the most effective electrical stimulation modality for increasing bone growth. 10 However, to date, augmenting skeletal fixation of intramedullary implants has not been highly evaluated in human or animal models. Animal studies conducted to date, have demonstrated the effectiveness of electrical stimulation in fracture healing situations by measuring the percentage of new bone growth in the medullary canal around the cathode site using a 28-gauge stainless steel wire.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of electrical stimulation for improving periprosthetic attachment

Isaacson

Brunker²,

Brown³

et al. 2011

J Biomed Mater Res

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Transcutaneous osseointegrated implants (TOI) have been shown to improve functionality for patients with limb loss by allowing direct skeletal attachment between an exoprosthesis and host bone. However, a lengthy rehabilitation period has limited the expansion of TOI and may be accelerated with electrical stimulation. The purpose of this study was to determine the ability of direct current (DC) cathode stimulation to enhance osseointegration of intramedullary implants in skeletally matured rabbits. Bilateral implants were inserted in the hind limbs of 25 adult female rabbits. The left hind limb of each animal was continually stimulated with a potential difference of 0.55 volts based on finite element analysis predictions. After sacrifice, the limbs were divided into two groups: Group I for histology and Group II for biomechanical testing. The bone-implant construct was evaluated in the Group I animals using appositional bone index (ABI), mineral apposition rates (MAR), histological staining, and scanning electron microscopy (SEM). Group II implants were sectioned and subjected to mechanical push-out tests. Data indicated no statistical differences for ABI, MAR, and porosity between the electrically stimulated implants (ESI) and the unstimulated control implants (UCI) at three weeks and six weeks. Higher mechanical push-out forces were observed in the UCI group at six weeks (p = 0.034). Data indicated that DC cathode stimulation may improve suboptimal implant "fit and fill" as an increase in trabecular bone was noted around the cathode in the ESI group. However, longer time duration animal studies and variations in electrical modalities may be required before electrically induced osseointegration becomes clinically feasible.

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“…Increased bone deposition may result from higher current densities at the bone-screw interface, consistent with prior studies demonstrating a positive correlation between DC density and osteogenic activity. 4,6,9 Quantitative analysis of interbody Fusion in explanted lumbar spines Quantitative analysis of average bone density across the L4-5 disc space confirmed successful interbody fusion in spines instrumented with osteogenic spinal sys- Fig. 9.…”

Section: Fig 6 Examination Of Fusion Mass At L4-5 Disc Space (Sagitmentioning

confidence: 86%

Novel spinal instrumentation to enhance osteogenesis and fusion: a preliminary study

MacEwan

Talcott²,

Moran³

et al. 2016

SPI

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OBJECTIVE Instrumented spinal fusion continues to exhibit high failure rates in patients undergoing multilevel lumbar fusion or pseudarthrosis revision; with Grade II or higher spondylolisthesis; or in those possessing risk factors such as obesity, tobacco use, or metabolic disorders. Direct current (DC) electrical stimulation of bone growth represents a unique surgical adjunct in vertebral fusion procedures, yet existing spinal fusion stimulators are not optimized to enhance interbody fusion. To develop an advanced method of applying DC electrical stimulation to promote interbody fusion, a novel osteogenic spinal system capable of routing DC through rigid instrumentation and into the vertebral bodies was fabricated. A pilot study was designed to assess the feasibility of osteogenic instrumentation and compare the ability of osteogenic instrumentation to promote successful interbody fusion in vivo to standard spinal instrumentation with autograft. METHODS Instrumented, single-level, posterior lumbar interbody fusion (PLIF) with autologous graft was performed at L4–5 in adult Toggenburg/Alpine goats, using both osteogenic spinal instrumentation (plus electrical stimulation) and standard spinal instrumentation (no electrical stimulation). At terminal time points (3 months, 6 months), animals were killed and lumbar spines were explanted for radiographic analysis using a SOMATOM Dual Source Definition CT Scanner and high-resolution Microcat II CT Scanner. Trabecular continuity, radiodensity within the fusion mass, and regional bone formation were examined to determine successful spinal fusion. RESULTS Quantitative analysis of average bone density in pedicle screw beds confirmed that electroactive pedicle screws used in the osteogenic spinal system focally enhanced bone density in instrumented vertebral bodies. Qualitative and quantitative analysis of high-resolution CT scans of explanted lumbar spines further demonstrated that the osteogenic spinal system induced solid bony fusion across the L4–5 disc space as early as 6 weeks postoperatively. In comparison, inactive spinal instrumentation with autograft was unable to promote successful interbody fusion by 6 months postoperatively. CONCLUSIONS Results of this study demonstrate that novel osteogenic spinal instrumentation supports interbody fusion through the focal delivery of DC electrical stimulation. With further technical development and scientific/clinical validation, osteogenic spinal instrumentation may offer a unique alternative to biological scaffolds and pharmaceutical adjuncts used in spinal fusion procedures.

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Electrically Induced Osteogenesis: Relationship between Charge, Current Density, and the Amount of Bone Formed

Cited by 69 publications

References 0 publications

Electrical stimulation of the growth plate: A potential approach to an epiphysiodesis

Electrical stimulation of the growth plate: A potential approach to an epiphysiodesis

An evaluation of electrical stimulation for improving periprosthetic attachment

Novel spinal instrumentation to enhance osteogenesis and fusion: a preliminary study

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