{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T14:07:49Z","timestamp":1693750069520},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Instrumented spinal fusion continues to exhibit high failure rates in patients undergoing multilevel lumbar fusion or pseudarthrosis revision; with Grade II or higher spondylolisthesis; or in those possessing risk factors such as obesity, tobacco use, or metabolic disorders. Direct current (DC) electrical stimulation of bone growth represents a unique surgical adjunct in vertebral fusion procedures, yet existing spinal fusion stimulators are not optimized to enhance interbody fusion. To develop an advanced method of applying DC electrical stimulation to promote interbody fusion, a novel osteogenic spinal system capable of routing DC through rigid instrumentation and into the vertebral bodies was fabricated. A pilot study was designed to assess the feasibility of osteogenic instrumentation and compare the ability of osteogenic instrumentation to promote successful interbody fusion in vivo to standard spinal instrumentation with autograft.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Instrumented, single-level, posterior lumbar interbody fusion (PLIF) with autologous graft was performed at L4\u20135 in adult Toggenburg\/Alpine goats, using both osteogenic spinal instrumentation (plus electrical stimulation) and standard spinal instrumentation (no electrical stimulation). At terminal time points (3 months, 6 months), animals were killed and lumbar spines were explanted for radiographic analysis using a SOMATOM Dual Source Definition CT Scanner and high-resolution Microcat II CT Scanner. Trabecular continuity, radiodensity within the fusion mass, and regional bone formation were examined to determine successful spinal fusion.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Quantitative analysis of average bone density in pedicle screw beds confirmed that electroactive pedicle screws used in the osteogenic spinal system focally enhanced bone density in instrumented vertebral bodies. Qualitative and quantitative analysis of high-resolution CT scans of explanted lumbar spines further demonstrated that the osteogenic spinal system induced solid bony fusion across the L4\u20135 disc space as early as 6 weeks postoperatively. In comparison, inactive spinal instrumentation with autograft was unable to promote successful interbody fusion by 6 months postoperatively.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Results of this study demonstrate that novel osteogenic spinal instrumentation supports interbody fusion through the focal delivery of DC electrical stimulation. With further technical development and scientific\/clinical validation, osteogenic spinal instrumentation may offer a unique alternative to biological scaffolds and pharmaceutical adjuncts used in spinal fusion procedures.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.1.spine13979","type":"journal-article","created":{"date-parts":[[2016,4,15]],"date-time":"2016-04-15T14:02:08Z","timestamp":1460728928000},"page":"318-327","source":"Crossref","is-referenced-by-count":2,"title":["Novel spinal instrumentation to enhance osteogenesis and fusion: a preliminary study"],"prefix":"10.3171","volume":"25","author":[{"given":"Matthew R.","family":"MacEwan","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, and"},{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael R.","family":"Talcott","sequence":"additional","affiliation":[{"name":"Division of Comparative Medicine, Washington University; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel W.","family":"Moran","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric C.","family":"Leuthardt","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, and"},{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine13979","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/S0140-6736(99)01312-4","article-title":"Epidemiological features of chronic low-back pain","volume":"354","author":"Andersson","year":"1999"},{"key":"b2-spine13979","series-title":"Nature","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1038\/204652a0","article-title":"Effects of electrical currents on bone in vivo","volume":"204","author":"Bassett","year":"1964"},{"key":"b3-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.1097\/00007632-199910150-00012","article-title":"In vivo evaluation of coralline hydroxyapatite and direct current electrical stimulation in lumbar spinal fusion","volume":"24","author":"Bozic","year":"1999"},{"issue":"161","key":"b4-spine13979","series-title":"Clin Orthop Relat Res","first-page":"122","article-title":"Electrically induced osteogenesis: relationship between charge, current density, and the amount of bone formed: introduction of a new cathode concept","author":"Brighton","year":"1981"},{"key":"b5-spine13979","series-title":"Med J Aust","doi-asserted-by":"publisher","first-page":"73","DOI":"10.5694\/j.1326-5377.1974.tb50762.x","article-title":"Direct current stimulation in spinal fusion","volume":"1","author":"Dwyer","year":"1974"},{"key":"b6-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1097\/00007632-200105010-00003","article-title":"The efficacy of direct current stimulation for lumbar inter-transverse process fusions in an animal model","volume":"26","author":"France","year":"2001"},{"issue":"24 Suppl","key":"b7-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"167S","DOI":"10.1097\/00007632-199512151-00016","article-title":"Interbody, posterior, and combined lumbar fusions","volume":"20","author":"Fraser","year":"1995"},{"key":"b8-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1097\/01.brs.0000251363.77027.49","article-title":"Effects of direct current electrical stimulation on gene expression of osteopromotive factors in a posterolateral spinal fusion model","volume":"32","author":"Fredericks","year":"2007"},{"key":"b9-spine13979","series-title":"Surg Gynecol Obstet","first-page":"894","article-title":"Bone reaction to varying amounts of direct current","volume":"131","author":"Friedenberg","year":"1970"},{"key":"b10-spine13979","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"915","DOI":"10.2106\/00004623-196648050-00009","article-title":"Bioelectric potentials in bone","volume":"48","author":"Friedenberg","year":"1966"},{"key":"b11-spine13979","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1097\/00005373-197110000-00010","article-title":"Healing of nonunion of the medial malleolus by means of direct current: a case report","volume":"11","author":"Friedenberg","year":"1971"},{"key":"b12-spine13979","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.2106\/00004623-197456050-00013","article-title":"The response of non-traumatized bone to direct current","volume":"56","author":"Friedenberg","year":"1974"},{"key":"b13-spine13979","series-title":"J Phys Soc Jpn","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1143\/JPSJ.12.1158","article-title":"On the piezoelectric effect of bone","volume":"12","author":"Fukada","year":"1957"},{"issue":"251","key":"b14-spine13979","series-title":"Clin Orthop Relat Res","first-page":"295","article-title":"The efficacy of direct current electrical stimulation to enhance canine spinal fusions","author":"Kahanovitz","year":"1990"},{"key":"b15-spine13979","series-title":"J Case Manag","first-page":"2","article-title":"The role of implantable direct current stimulation in the critical pathway for lumbar spinal fusion","volume":"2","author":"Kahanovitz","year":"1996"},{"key":"b16-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2523","DOI":"10.1097\/00007632-199611010-00026","article-title":"Spine update. The use of adjunctive electrical stimulation to enhance the healing of spine fusions","volume":"21","author":"Kahanovitz","year":"1996"},{"key":"b17-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1097\/00007632-198803000-00026","article-title":"Direct current electrical bone growth stimulation for spinal fusion","volume":"13","author":"Kane","year":"1988"},{"issue":"203","key":"b18-spine13979","series-title":"Clin Orthop Relat Res","first-page":"141","article-title":"Internal fixation in lumbar spine fusion","author":"Kornblatt","year":"1986"},{"key":"b19-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1097\/00007632-199903010-00012","article-title":"A controlled prospective outcome study of implantable electrical stimulation with spinal instrumentation in a high-risk spinal fusion population","volume":"24","author":"Kucharzyk","year":"1999"},{"issue":"8 Suppl","key":"b20-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S455","DOI":"10.1097\/00007632-199108001-00029","article-title":"A comparison of single-level fusions with and without hardware","volume":"16","author":"Lorenz","year":"1991"},{"key":"b21-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2393","DOI":"10.1097\/00007632-199411000-00004","article-title":"Direct current stimulation of allograft in anterior and posterior lumbar interbody fusions","volume":"19","author":"Meril","year":"1994"},{"key":"b22-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1097\/00007632-198603000-00014","article-title":"Stimulation of bone formation by electrical current on spinal fusion","volume":"11","author":"Nerubay","year":"1986"},{"key":"b23-spine13979","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1097\/00006123-200011000-00005","article-title":"Electrical bone graft stimulation for spinal fusion: a review","volume":"47","author":"Oishi","year":"2000"},{"key":"b24-spine13979","series-title":"Musculoskeletal Conditions in the United States","author":"Praemer","year":"1999"},{"key":"b25-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2479","DOI":"10.1097\/00007632-199611010-00014","article-title":"Efficacy of implanted bone growth stimulation in instrumented lumbosacral spinal fusion","volume":"21","author":"Rogozinski","year":"1996"},{"key":"b26-spine13979","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/00003086-199702000-00005","article-title":"Spinal instrumentation in the man-agement of degenerative disorders of the lumbar spine","volume":"335","author":"Sidhu","year":"1997"},{"key":"b27-spine13979","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1007\/s00586-009-0959-z","article-title":"Adverse effects of posterior lumbar interbody fusion using rhBMP-2","volume":"18","author":"Smoljanovic","year":"2009"},{"key":"b28-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.1097\/00007632-199608150-00015","article-title":"The use of implantable direct current stimulation in multilevel spinal fusion without instrumentation. A prospective clinical and radiographic evaluation with long-term follow-up","volume":"21","author":"Tejano","year":"1996"},{"key":"b29-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2580","DOI":"10.1097\/00007632-200010150-00007","article-title":"Direct current electrical stimulation increases the fusion rate of spinal fusion cages","volume":"25","author":"Toth","year":"2000"},{"key":"b30-spine13979","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1001\/jama.1992.03490070089049","article-title":"Patient outcomes after lumbar spinal fusions","volume":"268","author":"Turner","year":"1992"},{"issue":"16 Suppl","key":"b31-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1097\/01.brs.0000174559.13749.83","article-title":"Current treatment strategies for the painful lumbar motion segment: posterolateral fusion versus interbody fusion","volume":"30","author":"Wang","year":"2005"},{"key":"b32-spine13979","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1097\/00007632-199306150-00006","article-title":"A prospective, randomized study of lumbar fusion. Preliminary results","volume":"18","author":"Zdeblick","year":"1993"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/25\/3\/article-p318.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/25\/3\/article-p318.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/25\/3\/article-p318.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T22:04:08Z","timestamp":1681596248000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/25\/3\/article-p318.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9]]},"references-count":32,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2016.1.spine13979","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2016,9]]}}}