Asian Spine J.
2018 Dec;12(6):973-980. 10.31616/asj.2018.12.6.973.
Trends and Costs of External Electrical Bone Stimulators and Grafting Materials in Anterior Lumbar Interbody Fusion
- Affiliations
-
- 1Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. zbuser@usc.edu
- 2Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
- 3Department of Orthopaedic Surgery, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijongbu, Korea.
- 4Department of Orthopedics, Emory Spine Center, Atlanta, GA, USA.
- 5Spine Colorado, Durango, CO, USA.
- 6Department of Neurosurgery, Bergmannstrost Hospital, Halle, Germany.
- 7Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ, USA.
- 8Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- KMID: 2430628
- DOI: http://doi.org/10.31616/asj.2018.12.6.973
Abstract
- STUDY DESIGN: Retrospective review.
PURPOSE: 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.
OVERVIEW OF LITERATURE: 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.
METHODS
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.
RESULTS
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 R 2=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.
CONCLUSIONS
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.
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