Bone Growth Stimulators to Enhance Spinal Fusion Outcomes

Bone growth stimulators serve as a critical adjunct in spinal-fusion procedures, particularly in patients at risk of nonunion or delayed healing. This review analyzes three primary modalities: biological, electrical, and ultrasound-based stimulators. Biological stimulators, including bone morphogenic proteins and platelet-rich plasma, use growth factors to promote osteogenesis but carry risks such as ectopic bone formation and inflammatory responses. Electrical stimulators, such as direct current stimulation and pulsed electromagnetic fields, leverage the piezoelectric properties of bone to activate osteogenic pathways and have indicated significant efficacy in promoting fusion in high-risk populations. Low-intensity pulsed ultrasound offers a noninvasive alternative that accelerates bone healing through mechanical and angiogenic pathways. The review also evaluates the preclinical application of bone growth stimulators in animal models, exploring the integration of advanced biomaterials to further enhance osteogenesis. Future research should prioritize optimizing the efficacy, safety, and cost-effectiveness of these modalities to improve spinal-fusion outcomes.