D'Oro Anthony, Buser Zorica, Brodke Darrel Scott, Park Jong-Beom, Yoon Sangwook Tim, Youssef Jim Aimen, Meisel Hans-Joerg, Radcliff Kristen Emmanuel, Hsieh Patrick, Wang Jeffrey Chun
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Asian Spine J. 2018 Dec;12(6):973-980. doi: 10.31616/asj.2018.12.6.973. Epub 2018 Oct 16.
Retrospective review.
To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery.
A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion.
We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were performed using logistic regression analysis, chi-square test, and odds ratio (OR) analysis.
Approximately 19% of the patients (495/2,613) received external stimulators following ALIF surgery. There was a slight increase in stimulator use from 2008 to 2014 (multi-level R2=0.08, single-level R2=0.05). Patients who underwent multi-level procedures were more likely to receive stimulators than patients who underwent single-level procedures (p<0.05; OR, 3.72; 95% confidence interval, 3.02-4.57). Grafting options associated with most frequent stimulator use were bone marrow aspirates (BMA) plus autograft or allograft for single-level and allograft alone for multi-level procedures. In both cohorts, patients treated with bone morphogenetic proteins were least likely to receive electrical stimulators (p<0.05). Patients who received stimulation generally had higher reimbursements. Concurrent posterior lumbar fusion (PLF) (ALIF+PLF) increased the likelihood of receiving stimulators (p<0.05). Patients who received electrical stimulators had similar revision rates as those who did not receive stimulation (p>0.05), except those in the multilevel ALIF+PLF cohort, wherein the patients who underwent stimulation had higher rates of revision surgery.
Concurrent PLF or multi-level procedures increased patients' likelihood of receiving stimulators, however, the presence of comorbidities did not. Patients who received BMA plus autograft or allograft were more likely to receive stimulation. Patients with and without bone stimulators had similar rates of revision surgery.
回顾性研究。
确定刺激器使用的趋势，将这些趋势与各种移植材料进行配对，并确定刺激器对翻修手术风险的影响。
大量研究报告了电磁能量在长骨骨折愈合中的有益作用。然而，关于电刺激器在脊柱融合术中应用的临床研究较少。
我们使用保险计费代码识别接受前路腰椎椎间融合术（ALIF）的腰椎间盘退变患者。对术后接受和未接受电刺激器的患者进行逻辑回归分析、卡方检验和比值比（OR）分析。
约19%的患者（495/2613）在ALIF手术后接受了外部刺激器。2008年至2014年刺激器使用略有增加（多节段R2 = 0.08，单节段R2 = 0.05）。接受多节段手术的患者比接受单节段手术的患者更有可能接受刺激器（p<0.05；OR，3.72；95%置信区间，3.02 - 4.57）。与最频繁使用刺激器相关的移植选择是单节段手术采用骨髓抽吸物（BMA）加自体骨移植或同种异体骨移植，多节段手术采用单纯同种异体骨移植。在两个队列中，接受骨形态发生蛋白治疗的患者接受电刺激器的可能性最小（p<0.05）。接受刺激的患者通常报销费用更高。同期后路腰椎融合术（PLF）（ALIF + PLF）增加了接受刺激器的可能性（p<0.05）。接受电刺激器的患者与未接受刺激的患者翻修率相似（p>0.05），但多节段ALIF + PLF队列中的患者除外，其中接受刺激的患者翻修手术率更高。
同期PLF或多节段手术增加了患者接受刺激器的可能性，然而，合并症的存在并未增加。接受BMA加自体骨移植或同种异体骨移植的患者更有可能接受刺激。有和没有骨刺激器的患者翻修手术率相似。
