PT  - JOURNAL ARTICLE
AU  - Javeed, Saad
AU  - Zhang, Justin K.
AU  - Greenberg, Jacob K.
AU  - Dibble, Christopher F.
AU  - Zellmer, Eric
AU  - Moran, Dan
AU  - Leuthardt, Eric C.
AU  - Ray, Wilson Z.
AU  - MacEwan, Matthew R.
TI  - Electroactive Spinal Instrumentation for Targeted Osteogenesis and Spine Fusion: A Computational Study
AID  - 10.14444/8389
DP  - 2023 Jan 24
TA  - International Journal of Spine Surgery
PG  - 8389
4099  - https://www.ijssurgery.com/content/early/2023/01/24/8389.short
4100  - https://www.ijssurgery.com/content/early/2023/01/24/8389.full
AB  - Background Direct current electrical stimulation may serve as a promising nonpharmacological adjunct promoting osteogenesis and fusion. The aim of this study was to evaluate the utility of electroactive spine instrumentation in the focal delivery of therapeutic electrical stimulation to enhance lumbar bone formation and interbody fusion.Methods A finite element model of adult human lumbar spine (L4-L5) instrumented with single-level electroactive pedicle screws was simulated. Direct current electrical stimulation was routed through anodized electroactive pedicle screws to target regions of fusion. The electrical fields generated by electroactive pedicle screws were evaluated in various tissue compartments including isotropic tissue volumes, cortical, and trabecular bone. Electrical field distributions at various stimulation amplitudes (20–100 µA) and pedicle screw anodization patterns were analyzed in target regions of fusion (eg, intervertebral disc space, vertebral body, and pedicles).Results Electrical stimulation with electroactive pedicle screws at various stimulation amplitudes and anodization patterns enabled modulation of spatial distribution and intensity of electric fields within the target regions of lumbar spine. Anodized screws (50%) vs unanodized screws (0%) induced high-amplitude electric fields within the intervertebral disc space and vertebral body but negligible electric fields in spinal canal. Direct current electrical stimulation via anodized screws induced electrical fields, at therapeutic threshold of >1 mV/cm, sufficient for osteoinduction within the target interbody region.Conclusions Selective anodization of electroactive pedicle screws may enable focal delivery of therapeutic electrical stimulation in the target regions in human lumbar spine. This study warrants preclinical and clinical testing of integrated electroactive system in inducing target lumbar fusion in vivo.Clinical Relevance The findings of this study provide a foundation for clinically investigating electroactive intrumentation to enhance spine fusion.Level of Evidence 5.