Is a bone stimulator recommended after spine surgery?

Bone Stimulators After Spine Surgery: Not Recommended

Bone stimulators are not recommended after routine spine surgery as they have not demonstrated meaningful clinical benefit for improving outcomes related to morbidity, mortality, or quality of life. 1

Evidence Assessment

Primary Evidence Against Bone Stimulators

The BMJ clinical practice guideline (2017) provides the strongest and most recent evidence regarding bone stimulation devices. This guideline specifically examined low-intensity pulsed ultrasound (LIPUS) for bone healing and found:

• No significant impact on time to return to work, time to full weight bearing, pain, number of subsequent operations, or time to radiographic healing 1
• LIPUS represents a costly device that does not represent a wise use of healthcare resources 1
• The device can be cumbersome to use, with many patients reporting limited compliance 1

Specific Spine Surgery Considerations

The Praxis Medical Insights guideline on lumbar disc herniation (2025) does not include bone stimulators in its recommendations for post-surgical care, instead focusing on:

• Regular clinical and functional assessments following surgery 2
• Continued physical therapy to maintain range of motion and strength 2
• Radiographic assessment at 12 months post-surgery, or earlier if bone deformity worsens 2

Limited Supporting Evidence

While some older research suggests potential benefits of bone stimulators in specific circumstances:

• Direct current stimulation (DCS) may be an option for patients younger than 60 years of age, as it showed a positive effect on fusion rates in this population 3
• However, DCS did not appear to have an impact on fusion rates in patients over 60 years of age 3
• Electromagnetic stimulation has shown some improvement in healing of both bone and cartilage, particularly in high-risk populations 4

Clinical Applications

When Bone Stimulators Might Be Considered

Despite the general recommendation against routine use, bone stimulators might be considered in very specific scenarios:

• For treatment of established non-unions after spine surgery 3
• As an adjunctive therapy for patients at high risk for failed fusion, such as:
  • Smokers (tobacco use was a significant factor associated with increased time until healing) 5
  • Patients with deep soft tissue infection or osteomyelitis 5
  • Revision surgery for pseudarthrosis 3

Implementation Considerations

If a bone stimulator is used despite the general recommendation against it:

• Direct current stimulation requires placement of electrodes within the fusion substrate at the time of surgery 3
• Pulsed electromagnetic field stimulation (PEMFS) and capacitive coupled electrical stimulation (CCES) are non-invasive options, but have insufficient evidence to recommend for or against their use 3

Common Pitfalls and Caveats

• Overreliance on technology: There's a tendency to believe that additional technology like bone stimulators will improve outcomes, but evidence does not support this for routine spine surgeries
• Cost implications: Bone stimulators are expensive devices that may not be covered by health insurance 1
• Patient burden: The devices can be cumbersome to use, leading to poor compliance 1
• Focus on radiographic rather than clinical outcomes: Many studies focus on radiographic healing rather than patient-important outcomes like pain, function, and quality of life 1

Conclusion

Based on the most recent and highest quality evidence, bone stimulators should not be routinely recommended after spine surgery. The focus should instead be on established post-surgical care including physical therapy, appropriate pain management, and regular clinical follow-up.