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Does internal bone growth stimulation work? Here is how it is supposed to happen:
The internal or surgically implanted bone growth stimulator, utilizing direct current electrical stimulation, requires that the device cathode be placed directly at the fusion site and the generator be placed in a soft tissue pocket under the skin. The length of the device generator is as small as a half-dollar coin. Depending on how much soft tissue the patient has and/or how deep the generator (with batter pack) is implanted, most patients cannot feel or palpate the generator while under the skin. During a typical posterolateral gutter fusion surgery, the device is implanted just prior to placement of the bone graft material, and the electrical wires are placed in the posterolateral gutter with the goal of maximizing contact with as much viable bone as possible. Before closing, the generator is implanted. An effort is make to place the generator in a comfortable tissue pocket so that the patient’s skin contour is not raised or is minimally raised, thus enhancing the patient’s comfort.
The implantable device typically remains functional, delivering the therapeutic signal, for a minimum of six to nine months after implantation and may or may not be removed after fusion occurs. Removing the generator/battery pack is a simple procedure and is done most often under local anesthesia.
The precise mechanism of how the direct current (DC) technology works is not clearly understood. However, a number of physiologic changes have been documented. The fusion process is basically a race between the bone-forming cells (osteoblasts) and the bone-absorbing cells (osteoclasts). Direct current (DC) is known to enhance and the promotion and formation of cells (e.g. raises the pH and lowers the oxygen tension), thus changing the local acidity of the bone fusion bed which favors the bone-forming cells and inhibits the bone absorbing cells.3,4
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