Bone Growth Stimulators

Noninvasive electrical bone growth stimulators are used in cases where there is nonunion of a fracture. This technique has demonstrated effectiveness over the years since FDA approval in 1984. Electrical stimulation can be provided through a variety of technologies, with the end result being the generation of a weak electrical current.

There are many controversies related to definitions used in the criteria for when bone growth stimulation is appropriate. The controversies include definitions for nonunion, delayed union, and long versus short bones. Also, controversial are appropriate bone sites and the size of the fracture gap. Implantable devices are also the subject of debate. Most insurance carriers find these techniques appropriate for lumbar fusion, but not cervical fusion. Also, there is a trend to state that it is appropriate for non-union instead of delayed union. Some carriers find the technique appropriate for fresh fractures.

Bone growth stimulation heals fractures by applying a low electrical current or ultrasound. Ultrasound stimulation generates low intensity pulses of sound to the skin over the fracture. Ultrasound is a noninvasive procedure, while electric stimulation can be applied either invasively or non-invasively. Treatment is from three to six months. Recommended daily treatment may be as little as 20-30 minutes.

The PRC for Bone Growth Stimulators includes discussion of the documentation needed to support a status of nonunion, when appropriate for acute fractures, comorbidities that put a patient at higher risk for nonunion, conditions in which ultrasound is considered investigational, and when it is appropriate with spinal fusion, among other criteria.