title: Dorsal root ganglion electrical stimulation promoted intertransverse process spinal fusion without decortications and bone grafting: a proof-of-concept study.
abstract: BACKGROUND
  Periosteum, endosteum, and bone are innervated by sensory nerves expressing calcitonin gene-related peptide (CGRP), which is a known osteoanabolic peptide and plays an important role in fracture healing and spinal fusion. Synthesis and release of CGRP are found in sensory neurons located in the dorsal root ganglions (DRGs) and can be upregulated by electrical stimulation (ES) at DRG.
  
  
  OBJECTIVE
  To prove our study hypothesis on the potential of precise ES at DRG through implantable microelectrical stimulation system (IMESS) for its effect on promoting spinal fusion in a rat model without decortications and bone grafting.
  
  
  METHODS
  An experimental animal study.
  
  
  METHODS
  A novel IMESS was developed for stimulating L4-L6 DRG in rats. Sixteen rats were used and divided equally into the control group without ES and the ES group, with a daily 20 minutes ES to DRG for 6 weeks. At the end of 6 weeks, radiography and microcomputed tomography were conducted to evaluate new bone formation and spinal fusion. Bilateral L4-L6 DRGs were harvested for immunohistochemistry and quantification of neurons with upregulated CGRP expression.
  
  
  RESULTS
  In the ES group, rate of radiographic fusion with complete and uninterrupted bony bridging was 100% (8/8) at the right L4/L5 transverse processes and 75% (6/8) at the right L5/L6 transverse processes. Bony callus formation was absent at the left L4-L6 transverse processes in the ES group and in bilateral L4-L6 transverse processes in the control group.
  
  
  CONCLUSIONS
  We proved for the first time that precise ES at DRG through IMESS effectively promoted intertransverse process fusion in rat model without decortications and bone grafting. Electrical stimulation at DRG might be an attractive minimal invasive bioengineering approach and an alternative therapy for intertransverse process fusion that is increasingly being used for the treatment of degenerative spine disorders.
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: Yuen-Chi
authors.initials: YC
authors.lastname: Lau
authors.affiliation: Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: Yau-Ming
authors.initials: YM
authors.lastname: Lai
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: Kai-Ting
authors.initials: KT
authors.lastname: Po
authors.affiliation: School of Aerospace, Tsinghua University, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Qian
authors.affiliation: School of Aerospace, Tsinghua University, China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Hao
authors.affiliation: School of Aerospace, Tsinghua University, China.
authors.forename: Hu-Cheng
authors.initials: HC
authors.lastname: Zhao
authors.affiliation: School of Aerospace, Tsinghua University, China.
authors.forename: Lu-Ming
authors.initials: LM
authors.lastname: Li
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong. Electronic address: xia.guo@polyu.edu.hk.
authors.forename: Xia
authors.initials: X
authors.lastname: Guo
mesh_terms: D000818:Animals; D016025:Bone Transplantation; D015740:Calcitonin Gene-Related Peptide / Q000378:metabolism; D004558:Electric Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005727:Ganglia, Spinal / Q000378:metabolism / Q000502:physiology*; D008159:Lumbar Vertebrae / Q000378:metabolism / Q000601:surgery*; D051381:Rats; D017207:Rats, Sprague-Dawley; D011984:Sensory Receptor Cells / Q000378:metabolism / Q000502:physiology*; D013123:Spinal Fusion / Q000379:methods*
chemical_list: D015740:Calcitonin Gene-Related Peptide
keywords: Animal model; Calcitonin gene-related peptide; Dorsal root ganglion stimulation; Implantable microelectrical stimulation system; Minimally invasive; Spinal fusion