1085 Adjunctive Use of Bone Growth Stimulation in Cervical Spine Fusion in Patients at Risk for Nonunion

Abstract

INTRODUCTION: Prior failed fusion, multi-level disease, diabetes, nicotine usage, and osteoporosis are factors associated with nonunion, leading to prolonged pain, reduced function, and overall decreased quality of life. Previous studies have shown that pulsed electromagnetic field (PEMF) stimulation can improve fusion rates, particularly in subjects at risk for nonunion. METHODS: Data from a multi-center prospective study of subjects that underwent cervical spine fusion and were treated with PEMF was compared to a “matched” retrospective cohort that had fusion but were not treated with PEMF. The prospective cohort was enrolled based on having 1 or more of the following risk factors for nonunion: prior failed cervical spine fusion, multilevel fusion, diabetes, osteoporosis, or nicotine use. Fusion was assessed at 12 months postop using x-rays and/or CT. A cohort of cervical spine fusion patients that were prescribed PEMF, but did not receive PEMF treatment (e.g., insurance denial) were compared to PEMF treated subjects. RESULTS: At baseline, subjects in the PEMF treated group had a significantly higher average number of risk factors for nonunion (1.8 for treated group vs. 1.1 for control, p < 0.001), and significantly higher average number of surgical levels (2.8 for treated group vs. 2.0 for control, p < 0.005). At 12 months post-op, subjects in the PEMF group (n = 161) had a 90.1% fusion rate, compared to a 65.4% for the control group (n = 26) (p < 0.001). CONCLUSIONS: PEMF stimulation provides significant improvements in cervical spine fusion rates in subjects having risk factors for nonunion. Compared to control subjects, PEMF treated subjects had improved fusion outcomes despite being older, having more risk factors for pseudarthrosis, and undergoing more complex surgeries.