Comparison of the osteogenic effects between two surface interferential stimulation devices to enhance surgically based spinal fusion

K. K. Briggs; S. A. Martinez; L. V. Smith; W. J. Carroll; J. A. Zimmermann; M. S. Shih; R. Feldman; J. D. Lincoln

doi:10.1055/s-0038-1632792

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2004; 17(01): 41-47
DOI: 10.1055/s-0038-1632792

Original Research

Schattauer GmbH

Comparison of the osteogenic effects between two surface interferential stimulation devices to enhance surgically based spinal fusion^[*]

Authors

K. K. Briggs

¹Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
S. A. Martinez

¹Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
L. V. Smith

²School of Mechanical and Materials Engineering (Smith), Washington State University, Pullman, WA, USA
W. J. Carroll

³RS Medical, Vancouver, WA USA
J. A. Zimmermann

¹Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
M. S. Shih

⁴SkeleTech Inc., Bothell, WA, USA
R. Feldman

⁴SkeleTech Inc., Bothell, WA, USA
J. D. Lincoln

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

Abstract

Summary

In human medicine, lumbar spinal fusion procedures for chronic degenerative conditions have significant failure rates leading to the formation of pseudoarthroses. Adjunct procedures including the use of electrical stimulation devices have been developed in animal models, and utilized in human clinical cases, in an attempt to reduce the incidence of nonunion. A randomized, controlled study was performed to compare the effects of two surface interferential stimulation devices (SIS) on a rabbit lumbar spinal fusion model. Twenty-five rabbits underwent bilateral intertransverse process arthrodesis at the L2-L3 disc space. The rabbits were divided into five groups: one control group receiving sham stimulation, and four treatment groups receiving interferential stimulation from one of two devices (RS4i at 13.3 mA, RS4i at 15.8 mA, RS4v at 11.6 mA, and RS4v at 14.8 mA). Dual energy X-ray absorptiometry analyses (DXA) were performed and at 2 week intervals to evaluate fusion site bone mineral density. All rabbits were euthanitized at eight weeks and fusion sites were evaluated for biomechanical strength and histomorphometric properties. There was not any difference in bone mineral density between the groups during the eight week test period. The uniaxial tension tests evaluating maximum load to failure, stiffness, and energy absorbed also resulted in no statistical differences between the groups. The RS4i device at 15.8 mA yielded an increased amount of lamellar bone compared to the control group (p = 0.02). The RS4v device at 11.6 mA resulted in less total bone than the control group (p = 0.04).

Full Text

References

References
1 Albert TJ, Pinto M, Denis F. Management of symptomatic lumbar pseudoarthrosis with anteroposterior fusion: A functional and radiographic outcome study. Spine 2000; 25: 123-9.
2 Bassett CA. Beneficial effects of electromagnetic fields. J Cell Biochem 1993; 51: 387-93.
3 Boden SD, Greyer SJ, Levy HI. Management of low back pain. Current assessment and formulation of a blueprint for the health care delivery system of the future. Phy Med Rehab Clin N Am 1998; 09: 419-33.
4 Boden SD, Schimandle JH, Hutton WC. An experimental lumbar intertransverse process spinal fusion model: radiographic, histologic, and biomechanical healing characteristics. Spine 1995; 20: 412-20.
5 Boden SD, Schimandle JH, Hutton WC. The use of an osteoinductive growth factor for lumbar spinal fusion; part I: biology of spinal fusion. Spine 1995; 20: 2626-32.
6 Bozic KJ, Glazer MD, Zurakowski D. In vivo evaluation of coralline hydroxyapatite and direct current electrical stimulation in lumbar spinal fusion. Spine 1999; 24: 2127-33.
7 Collier MA, Brighton CT, Norrdin R. Direct current stimulation of bone production in the horse: preliminary study with a “gap healing” model. Am J Vet Res 1984; 46: 610-21.
8 Collier MA, Brighton CT, Rendano VT. Direct current stimulation of bone production in the pony: observations with a diaphyseal osteotomy model. Am J Vet Res 1984; 46: 600-9.
9 Collier MA, Kallfelz FA, Rendano VT. Capacitively coupled electrical stimulation of bone healing in the horse: in vivo study with a Salter type IV osteotomy model with stainless steel surface electrodes. Am J Vet Res 1985; 46: 622-31.
10 Dwyer AF, Wickham GG. Direct current stimulation in spine fusion. Med J Aust 1974; 01: 73-4.
11 Feiertag MA, Boden SD, Schimandle JH. A rabbit model for nonunion of lumbar intertransverse process spine arthrodesis. Spine 1996; 21: 27-30.
12 Fourie JA, Bowerbank P. Stimulation of bone healing in new fractures of the tibial shaft using interferential currents. Physiother Res Int 1997; 02: 255-68.
13 Fuentes RA, Marcondes JPde Souza, Valeri V. Experimental model of electric stimulation of pseudoarthrosis healing. Clin Orthop 1984; 183: 267-75.
14 Fukada E, Yasuda I. On the piezoelectric effect in bone. J Physiol Soc Jpn 1957; 12: 1158-62.
15 Ganne JM, Speculand B, Mayne LH. Interferential therapy to promote union of mandibular fractures. Aust N Z J Surg 1979; 49: 81-3.
16 Goats GC. Interferential current therapy. Br J Sp Med 1990; 24: 87-92.
17 Goodwin CB, Brighton CT, Guyer RD. A double-blind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions. Spine 1999; 24: 1349-57.
18 Guizzardi S, Silvestre M, Govoni P. Pulsed electromagnetic field stimulation on posterior spinal fusions: a histological study in rats. J Spinal Disord 1994; 07: 36-40.
19 Jervey C, Friedman RJ. Electrical stimulation: current concepts and indications. Contemp Orthop 1990; 20: 61-5.
20 Johnson MI, Tabasam G. An investigation into the analgesic effects of interferential currents and transcutaneous electrical nerve stimulation on experimentally induced ischemic pain in otherwise pain-free volunteers. Phys Ther 2003; 83: 208-23.
21 Joos U, May HU, Mittermayer C. Stimulation of fibroblast proliferation by means of electrical current. 8^th Int Conf Oral Surg, Berlin, 1983
22 Katz JN, Spratt KF, Andersson GB. et al. Epidemiology introduction. Spine 1995; 20 (suppl): S76-7.
23 Laabs WA, May E, Richter KD. Knochenheilung und dynamischer Interferenzstrom (DIC) Erste vergleichende tierexperimentelle Studie an Schafen. Teil II: physikalische und chemische Ergebnisse. Langenbecks Arch Chir 1982; 356: 231-41.
24 Laabs WA, May E, Richter KD. Knochenheilung und dynamischer Interferenzstrom (DIC) Erste vergleichende tierexperimentelle Studie an Schafen. Teil I: experimentelles Vorgehen und histologische Ergebnisse. Langenbecks Arch Chir 1982; 356: 219-29.
25 Mammi GI, Rocchi R, Cadossi R. The electrical stimulation of tibial osteotomies: double blind study. Clin Orthop 1993; 246-53.
26 May HU, Nippel FJ, Hansjurgens A. Acceleration of ossification by means of interferential current. Prog Clin Biol Res 1985; 187: 469-78.
27 Mooney V. A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions. Spine 1990; 15: 708-12.
28 Muschler GF, Huber B, Ullman T. Evaluation of bone grafting materials in a new canine segmental spinal fusion model. J Orthop Res 1993; 11: 514-24.
29 Nikolova-Troeva L. Physiotherapeutic rehabilitation in the presence of fracture complication. Munch Med Wochensch 1969; 111: 592-99.
30 Nugent PJ, Dawson EG. Intertransverse process lumbar arthrodesis with allogenic freshfrozen bone graft. Clin Orthop 1993; 287: 107-11.
31 Steinmann JC, Herkowitz HN. Pseudoarthrosis of the spine. Clin Orthop 1992; 284: 80-90.

Comparison of the osteogenic effects between two surface interferential stimulation devices to enhance surgically based spinal fusion[*]

Authors

Comparison of the osteogenic effects between two surface interferential stimulation devices to enhance surgically based spinal fusion^[*]