Noninvasive electrical stimulation is a type of technology that is used to improve fusion rates. However, just a few research have provided evidence on the effects of noninvasive electrical stimulation. The purpose of this systematic review and meta-analysis was to investigate the effects of non-invasive electrical stimulation used as a supplement to fusion operations to improve fusion rates. The search method and PRISMA recommendations searched PubMed, Embase, and the Cochrane Clinical Trials Database. R version 4.1.0 was used to conduct random-effects meta-analyses of fusion rates using the three main noninvasive electrical stimulation modalities, capacitively coupled stimulation (CCS), pulsed electromagnetic fields (PEMFs), and combined magnetic fields (CMFs) (The R Foundation for Statistical Computing). There were retrospective investigations as well as clinical trials included. The Risk of Bias 2 (RoB 2) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tools were used by Researchers to assess the risk of bias.
From 213 preliminary results, PubMed, Embase, and the Cochrane Clinical Trials database yielded 8 publications, with 1216 people fitting the criterion. The majority of randomized studies were found to have a significant overall risk of bias. There was no way to do a meta-analysis for CCS because they found only one paper. There was no difference between treatment and control groups in a meta-analysis of six investigations evaluating PEMF fusion rates (OR 1.89, 95% CI 0.36–9.80, p=0.449). There was no difference in fusion rates between the control and treatment groups in a meta-analysis of two CMF investigations (OR 0.90, 95% CI 0.07–11.93, p=0.939). Due to the short number of trials and patients, subgroup analysis of PEMF was limited, but several subgroups showed considerably higher fusion rates. There were no increased infusion rates for any modality in this meta-analysis of clinical outcomes and fusion rates in noninvasive electrical stimulation relative to no stimulation. There was a lot of variation between the trials. Although subgroup analysis revealed substantial differences in fusion rates in specific populations, these findings were based on a small number of trials, indicating that more research is needed. Although the data is constrained by a significant risk of bias and a small number of accessible studies, this research does not support the routine use of these devices to boost fusion rates.
