title: Direct current electrical stimulation increases the fusion rate of spinal fusion cages.
abstract: METHODS
  A randomized experimental evaluation of direct current stimulation in a validated animal model with an experimental control group, using blinded radiographic, biomechanical, histologic, and statistical measures.
  
  
  OBJECTIVE
  To evaluate the efficacy of the adjunctive use of direct current stimulation on the fusion rate and speed of healing of titanium interbody fusion cages packed with autograft in a sheep lumbar interbody fusion model.
  
  
  BACKGROUND
  Titanium lumbar interbody spinal fusion cages have been reported to be 90% effective for single-level lumbar interbody fusion. However, fusion rates are reported to be between 70% and 80% in patients with multilevel fusions or with risk factors such as obesity, tobacco use, or metabolic disorders. The authors hypothesized that direct current stimulation would increase the fusion rate of titanium interbody fusion cages packed with autograft in a sheep lumbar interbody fusion model.
  
  
  METHODS
  Twenty-two sheep underwent lumbar discectomy and fusion at L4-L5 with an 11- x 20-mm Bagby and Kuslich (BAK) cage packed with autograft. Seven sheep received a BAK cage and no current. Seven sheep had a cage and a 40-microA current applied with a direct current stimulator. Eight sheep had a BAK cage and a 100-microA current applied. All sheep were killed 4 months after surgery. The efficacy of electrical stimulation in promoting interbody fusion was assessed by performing radiographic, biomechanical, and histologic analyses in a blinded fashion.
  
  
  RESULTS
  The histologic fusion rate increased as the direct current dose increased from 0 microA to 40 microA to 100 microA (P < 0.009). Histologically, all animals in the 100-microA group had fusions in both the right and left sides of the cage. Direct current stimulation had a significant effect on increasing the stiffness of the treated motion segment in right lateral bending (P < 0.120), left lateral bending (P < 0.017), right axial rotation (P < 0.004), left axial rotation (P < 0.073), extension (P < 0.078), and flexion (P < 0.029) over nonstimulated levels.
  
  
  CONCLUSIONS
  Direct current stimulation increased the histologic and biomechanical fusion rate and the speed of healing of lumbar interbody spinal fusion cages in an ovine model at 4 months.
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226-0099, USA. jtoth@mcw.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Toth
authors.forename: H B
authors.initials: HB
authors.lastname: Seim
authors.forename: J D
authors.initials: JD
authors.lastname: Schwardt
authors.forename: W B
authors.initials: WB
authors.lastname: Humphrey
authors.forename: J A
authors.initials: JA
authors.lastname: Wallskog
authors.forename: A S
authors.initials: AS
authors.lastname: Turner
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D015194:Diffusion Chambers, Culture / Q000295:instrumentation* / Q000379:methods; D004195:Disease Models, Animal; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D016268:Internal Fixators / Q000592:standards*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012756:Sheep / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013131:Spine / Q000166:cytology / Q000000981:diagnostic imaging / Q000601:surgery*; D014182:Transplantation, Autologous / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome