Augmentation of intertransverse process lumbar fusion

Michael A. Nawrocki; Steven A. Martinez; Joanne Hughes; James D. Lincoln; Mei-Shu Shih; Hellen Zheng; William J. Carroll

doi:10.1055/s-0038-1632978

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2006; 19(02): 72-80
DOI: 10.1055/s-0038-1632978

Original Research

Schattauer GmbH

Augmentation of intertransverse process lumbar fusion

Michael A. Nawrocki

¹Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, USA

,

Steven A. Martinez

¹Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, USA

,

Joanne Hughes

¹Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, USA

,

James D. Lincoln

¹Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, USA

,

Mei-Shu Shih

²keletech Inc., Bothell, Washington, USA

,

Hellen Zheng

²keletech Inc., Bothell, Washington, USA

,

William J. Carroll

³RS Medical, Vancouver, Washington, USA

› Author Affiliations

Abstract

Summary

Spinal fusion surgery for alleviation of intractable lower back pain in humans is currently a primary therapeutic technique, with failure rates averaging between 5 to 35%. Implanted and external source-based electrical stimulation devices have been investigated in an attempt to increase osteogenesis at the fusion site in an attempt to reduce spinal fusion failure rates. The purpose of our study was to evaluate the efficacy of two co-processor systems and an additional system with an SIS generation field at 15.8 mA (rms) using biomechanical, dual-energy X-ray absorptiometry (DXA), and histomorphometric analyses, in rabbits following dorsolateral (= posteriolateral [in humans]) spinal fusion. Fifty-six male New Zealand White underwent bilateral lumbar spinal fusion by performing decortication of the transverse processes of lumbar vertebrae four and five with placement of autogenic cancellous bone graft harvested from the ilial wings. Four study groups were designated based on the type of IES device used for stimulation or as a control. Eight weeks after surgery all subjects were sacrificed and the quality and strength of the fusion masses were compared using radiographic, biomechanical, histomorphometry, and qualitative histological evaluation. While some variation existed within and between groups, Group 2 showed a significant improvement in all parameters measured as compared to the control group (P<0.05). The use of adjunct non-invasive surface IES for improving bony fusion rates for patients undergoing lumbar spinal fusion is supported by this study.

Keywords

Interferential stimulation - spinal fusion - posteriolumbar fusion - rabbit

Full Text

References

References
1 Albert TJ, Pinto M, Denis F. Management of Symptomatic Lumbar pseudoarthosis with anteroposterior fusion: A functional and radiographic outcome study. Spine 2000; 25: 123-9.
2 Boden S, Schimandle J, Hutton W. An Experimental Lumbar Intertransverse Process Spinal Fusion Model. Spine 1995; 20: 412-20.
3 Steinmann JC, Herkowitz HN. Pseudoarthrosis of the spine. Clin Orthop 1992; 284: 80-90.
4 Christensen F, Hansen E, Eiskjaer S. et al. Circumferential Lumbar Spinal Fusion with Brantigan Cage Versus Posterolateral Fusion with Titanium Cortrel-Dubousset Instrumentation: A Prospective, Randomized Clinical Study of 146 Patients. Spine 2002; 27 (23) 2674-83.
5 Chrintensen F, Hansen E, Laursen M. et al. Long-Term Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion. Spine 2002; 27 (12) 1269-77.
6 Johnsson R, Stromqvist B, Aspenberg P. Randomized Radiosterometric Study Comparing Osteogenic Protein-1 (BMP-7) and Autograft Bone in Human Noninstrumented Posterolateral Lumbar Fusion. Spine 2002; 27 (23) 2654-61.
7 Fuentes RA, Marcondes de Souza JP, Valeri V. Experimental model of electric stimulation of pseu-doarthorsis healing. Clin Orthop Relat Res 1984; 183: 267-75.
8 Rogosinski A, Rogozinski C. Efficacy of implanted bone growth stimulation in instrumented lumbosacral spinal fusion. Spine 1996; 21: 2479-83.
9 Meril A. Direct Current stimulation of allograft in anterior and posterior lumbar interbody fusions. Spine 1994; 19 (21) 2393-8.
10 Ghanayem A, Stanwood W, Voronov L. et al. The effects of external pulsed electromagnetic field stimulation in promoting lumbar fusion in a rabbit model. 47th Annual Meeting. Orthopaedic Research Society February; 25-28 2001
11 Goodwin CB, Brighton CT, Guyer RD. A doubleblind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions. Spine 1999; 24: 1349-57.
12 Mooney V. A Randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions. Spine 1991; 15: 708-12.
13 Aro HT, Chao E. Bone healing patterns affected by loading, fracture stability, fracture type, and fracture site compression. Clin Orthop Relat Res 1993; 293: 8-17.
14 Goodship AE, Kenwright J. The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg 1985; 67B: 650-5.
15 Kenwright J, Goodship AE. Controlled mechanical stimulation in the treatment of tibial fractures. Clin Orthop Relat Res 1989; 241: 36-47.
16 Brighton C, Hunt R. Ultrastructure of electrically induced osteogenesis in the rabbit medullary canal. J Orth Res 1986; 4: 27-36.
17 Collier MA, Brighton CT, Norrdin R. Direct current stimulation ofbone production in the horse: preliminary study with a “gap healing” model. Am J Vet Res 1984; 46: 600-9.
18 Mammi GI, Rocchi R, Cadossi R. The electrical stimulation of tibial osteotomies: double blind study. Clin Orthop 1993; 246-53.
19 Masoud I, Shapiro F, Kent R. et al. A longitudinal study of the growth of the New Zealand White Rabbit: Cumulative and biweekly incremental growth rates for body length, femoral length, and tibia length. J Orthopaedic Research 1986; 4: 221-31.
20 Spadro D, Mino S, Chase F. et al. Mechanical factors in electrode-induced osteogenesis. J Orth Res 1986; 4: 37-44.
21 Briggs K, Martinez S, Smith L. et al. Comparison of the osteogenic effects between two surface interferential stimulation devices to enhance surgically based spinal fusion. Vet Comp Orthop Traumatol 2004; 1: 41-7.
22 Greenaway B, Partlow G, Gonsholt N. et al. Anatomy of the Lumbosacral Spinal Cord in Rabbits. J Am Anim Hosp Assoc 2001; 37: 27-34.
23 Guizzardi S, DiSilvestre M, Govoni P. Pulsed electromagnetic field stimulation on posterior spinal fusions: a histological study in rats. J Spinal Disord 1994; 7: 36-40.
24 Jervey C, Friedman RJ. Electical stimulation: Current concepts and indications. Contemp Orthop 1990; 20: 61-5.
25 Parfitt A. The physiologic and clinical significance ofbone histomorphometric data. In Recker R: Bone Histomorphometry: Techniques and Interpretation CRC Press Inc., Boca Raton 2000; 143-224.
26 Feiertag MA, Boden SD, Schimandle JH. Arabbit model for non-union of lumbar intertransverse process spine arthrodesis. Spine 1996; 21: 27-30.
27 DeVries WJ, Runyon CL, Martinez SA. et al. Effect of volume variations on osteogenic capabilities of autogenous cancellous bone graft in dogs. Am J Vet Res 1996; 57: 1501-5.