Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam si, Republic of Korea.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Spine J. 2019 Jun;19(6):1106-1120. doi: 10.1016/j.spinee.2018.12.011. Epub 2018 Dec 22.
BACKGROUND CONTEXT: Posterolateral fusion (PLF) with autogenous iliac bone graft is one of the most common surgical procedures for lumbar spinal disease. However, its limited success demands new biologically competent graft enhancers or substitutes. Although the use of direct current (DC) electrical stimulation has been shown to increase rate of successful spinal fusions, little is known about the effect of the type of current in DC stimulation. PURPOSE: To evaluate the effects of various DC stimulators on the strength and success rate of posterolateral fusion facilitated by using a nitinol mesh container, in rats. STUDY DESIGN: This was an experimental animal study. METHODS: A conductive, tubular nitinol mesh container was used to carry small pieces of bone grafts. The nitinol mesh container received electrical stimulation via a lead that connected the container to different types of DC stimulators. Sixty male Sprague-Dawley rats were divided into three groups (N=20 in each): a control group that underwent PLF with a nitinol container filled with autograft, a constant DC group that received a nitinol container and constant DC (100 μA), and a pulsed DC group that received a nitinol container and pulsed DC (100 μA, 100 Hz, 200 μs). The rats underwent PLF between L4 and L5, and transverse processes were grafted with bilateral iliac grafts. A stimulator was implanted subcutaneously. The rats were sacrificed 8 weeks postsurgery, and lumbar spines were removed. Spinal fusion was evaluated by microcomputed tomography, manual testing, biomechanical testing, histologic examination, and molecular analysis. RESULTS: All animals in the DC stimulation groups displayed solid fusion, whereas only 70% of control animals showed solid fusion. Radiographic images, biomechanical testing, histologic examination, and molecular analysis revealed improved fusion in the order control group<constant DC group<pulsed DC group. The volume of new bone mass was significantly higher in the pulsed DC group (p<.05). Fusion was more solid in the pulsed DC group than in control group (p<.05). The pulsed DC group displayed the lowest inflammatory responses. CONCLUSIONS: Pulsed DC electrical stimulation is efficacious in improving both strength and fusion rate in a rat spinal fusion model. In addition, tubular nitinol mesh, made of conductive suture, appears useful for holding small pieces of bone grafts and maintaining a good environment for bone fusion. CLINICAL RELEVANCE: Pulsed DC electrical stimulation may be potentially useful to increase the fusion rate after spinal fusion in humans. Future research is required to evaluate the safety and efficacy of tubular nitinol mesh and pulsed DC electrical stimulation in humans.
背景：自体髂骨移植后路横突间植骨融合术是治疗腰椎疾病最常见的手术之一。然而，其有限的成功率需要新的生物相容的移植物增强剂或替代品。虽然直流电（DC）电刺激已被证明可以增加脊柱融合的成功率，但对于 DC 刺激中电流类型的影响知之甚少。 目的：评估使用镍钛诺网容器的各种 DC 刺激器对后路横突间植骨融合强度和成功率的影响，实验动物为大鼠。 研究设计：这是一项实验动物研究。 方法：使用导电管状镍钛诺网容器携带小块骨移植物。镍钛诺网容器通过连接容器和不同类型的 DC 刺激器的引线接收电刺激。将 60 只雄性 Sprague-Dawley 大鼠分为三组（每组 20 只）：一组接受后路横突间植骨融合术，使用镍钛诺容器填充自体移植物；一组接受镍钛诺容器和恒定直流电（100 μA）；一组接受镍钛诺容器和脉冲直流电（100 μA，100 Hz，200 μs）。大鼠在 L4 和 L5 之间进行 PLF，并在双侧横突处移植髂骨移植物。植入皮下刺激器。术后 8 周处死大鼠，取出腰椎。通过 microCT、手动测试、生物力学测试、组织学检查和分子分析评估脊柱融合情况。 结果：所有 DC 刺激组的动物均显示出坚固的融合，而仅 70%的对照组动物显示出坚固的融合。放射学图像、生物力学测试、组织学检查和分子分析显示，融合效果依次为对照组<恒定直流电组<pulsed DC 组。脉冲直流电组的新骨量明显更高（p<.05）。脉冲直流电组的融合比对照组更牢固（p<.05）。脉冲直流电组显示出最低的炎症反应。 结论：脉冲直流电刺激在改善大鼠脊柱融合模型的强度和融合率方面是有效的。此外，由导电缝线制成的管状镍钛诺网对于固定小块骨移植物和维持良好的骨融合环境非常有用。 临床相关性：脉冲直流电刺激可能有助于增加人类脊柱融合后的融合率。需要进一步的研究来评估管状镍钛诺网和脉冲直流电刺激在人类中的安全性和有效性。
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