The Effect of Electrical Stimulation on Lumbar Spinal Fusion in Older Patients: A Randomized, Controlled, Multi-Center Trial

Andersen, Thomas; Christensen, Finn Kjær; Egund, Niels; Ernst, Carsten; Fruensgaard, Søren; Østergaard, Jane Nautrup; Andersen, Jens Langer; Rasmussen, Sten; Niedermann, Bent; Høy, Kristian; Helmig, Peter; Holm, Randi; Lindblad, Bent Erling; Hansen, Ebbe Stender; Bünger, Cody

doi:10.1097/brs.0b013e3181b02c59

Cited by 27 publications

(35 citation statements)

References 53 publications

(48 reference statements)

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“…Nevertheless significant less bone mineral was present at the fusion site in the non-unions as compared to those solidly fused. This might also explain why the association between fusion mass BMD and functional outcome was weaker than that observed in the primary report between CT-based fusion rate and functional outcome [3]. This study demonstrates that the quality of the posterolateral fusion mass is dependant on several factors.…”

Section: Discussioncontrasting

confidence: 50%

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Fusion mass bone quality after uninstrumented spinal fusion in older patients

et al. 2010

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Older people are at increased risk of non-union after spinal fusion, but little is known about the factors determining the quality of the fusion mass in this patient group. The aim of this study was to investigate fusion mass bone quality after uninstrumented spinal fusion and to evaluate if it could be improved by additional direct current (DC) electrical stimulation. A multicenter RCT compared 40 and 100 lA DC stimulation with a control group of uninstrumented posterolateral fusion in patients older than 60 years. This report comprised 80 patients who underwent DEXA scanning at the 1 year follow-up. The study population consisted of 29 men with a mean age of 72 years (range 62-85) and 51 women with a mean age of 72 years (range 61-84). All patients underwent DEXA scanning of their fusion mass. Fusion rate was assessed at the 2 year follow-up using thin slice CT scanning. DC electrical stimulation did not improve fusion mass bone quality. Smokers had lower fusion mass BMD (0.447 g/cm 2 ) compared to non-smokers (0.517 g/cm 2 ) (P = 0.086). Women had lower fusion mass BMD (0.460 g/ cm 2 ) compared to men (0.552 g/cm 2 ) (P = 0.057). Using linear regression, fusion mass bone quality, measured as BMD, was significantly influenced by gender, age of the patient, bone density of the remaining part of the lumbar spine, amount of bone graft applied and smoking. Fusion rates in this cohort was 34% in the control group and 33 and 43% in the 40 and 100 lA groups, respectively (not significant). Patients classified as fused after 2 years had significant higher fusion mass BMD at 1 year (0.592 vs. 0.466 g/cm 2 , P = 0.0001). Fusion mass bone quality in older patients depends on several factors. Special attention should be given to women with manifest or borderline osteoporosis. Furthermore, bone graft materials with inductive potential might be considered for this patient population.

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Section: Discussioncontrasting

confidence: 50%

“…The main results of the study are reported elsewhere [3,4]. The study included patients of 60 years or above, eligible for spinal fusion.…”

Section: Methodsmentioning

confidence: 99%

Fusion mass bone quality after uninstrumented spinal fusion in older patients

et al. 2010

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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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“…They were recruited from two previously reported cohorts. The first cohort consisted of 100 patients undergoing uninstrumented fusion with or without direct current-stimulation as part of a clinical trial [3]. Inclusion criteria were spinal stenosis surgery, where additional fusion was deemed necessary due to instability or the need for extensive decompression, or a significant degree of back pain indicating that additional fusion could be beneficial.…”

Section: Patient Populationmentioning

confidence: 99%

Long-term health care utilisation and costs after spinal fusion in elderly patients

2012

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Purpose Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the longterm effects in terms of health care use are largely unknown. The aim of the present study was to describe the long-term consequences of spinal fusion surgery in elderly patients on health care use and costs using a health care system perspective. Methods 194 patients undergoing spinal fusion between 2001 and 2005 (70 men, 124 women) with a mean age of 70 years (range 59-88) at surgery were included. Average length of follow-up was 6.2 years (range 0.3-9.0 years). Data on resource utilisation and costs were obtained from national registers providing complete coverage of all reimbursed contacts with primary-and secondary health care providers. Data were available from 3 years prior fusion surgery until the end of 2009. Results Use of hospital-based health care increased in the year prior to and the first year following surgery. Hereafter it normalised to the level of the background population and was mainly composed of diseases unrelated to the spine. In contrast, the use of primary health care appeared to increase immediately after surgery and continued to increase to a level that significantly exceeded that of the background population. It could be demonstrated that the increase was mainly due to an increasing number of general practitioner consultations. Conclusion Spinal fusion surgery in older patients does not generate excess hospital-based health care use in the longer term as compared with the background population, but primary care use increases.

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The Effect of Electrical Stimulation on Lumbar Spinal Fusion in Older Patients: A Randomized, Controlled, Multi-Center Trial

Abstract: Thin slice CT revealed very high nonunion rates after uninstrumented spinal fusion in older patients. DC-stimulation was not effective in increasing fusion rates in this patient population. The achievement of a solid fusion was associated with superior functional outcome.

Cited by 27 publications

References 53 publications

Fusion mass bone quality after uninstrumented spinal fusion in older patients

Fusion mass bone quality after uninstrumented spinal fusion in older patients

Electrical Stimulation to Enhance Spinal Fusion: A Systematic Review

Long-term health care utilisation and costs after spinal fusion in elderly patients

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