## 2 Application Fields
### Spinal Surgery  
The usefulness of biophysical stimulation has also been investigated in the field of spinal surgery to improve the outcome of patients after lumbar spinal fusion surgeries. The double-blind prospective randomized multicenter study conducted by [PERSON] et al. [30] in 2020 reports results relating to clinical symptoms in this area following the use of CCEFs for 90 days. In this study, forty-two patients undergoing LSF were assessed and randomly allocated to either the active or to the placebo group. Follow-up visits were performed at 1, 3, 6, and 12 months after surgery. The treatment was started 7 days after the surgery and included the application of CCEFs for 9 h a day. The device was able to stimulate the area between two intervertebral disk spaces. The Visual Analogue Scale (VAS) for pain, the 36-item Short Form Health Survey (SF-36), and the Oswestry Disability Index (ODI) for functional results were used to assess efficacy. In the active group, positive results both in the short and long term with regard to symptoms were reported by patients. For this reason, the authors conclude by advocating the usefulness of these therapies to improve quality of life.  
In 2009, [PERSON] et al. [31] described the main fields of use of PEMFs and their rational science considering several published studies. The study also produces an algorithm to guide the orthopedic surgeon in identifying whether the patient is suitable for biophysical stimulation and when and how to evaluate the results of stimulation. The authors have reported the usefulness of biophysical therapies in bone healing, emphasizing the importance of both the correct therapeutic indication by the clinician and the adherence by the patient. This last statement seems essential to obtain satisfactory results, so the achievement of the final goal requires correct information for the patient.  
More recently, a study was conducted by [PERSON] et al. [32] in 2021 on a population of 82 female patients surgically treated with percutaneous verteboplasty for vertebral fractures due to osteoporosis. The patients selected were aged 60-75. Statistically significant differences were observed already at 1 month of follow-up regarding the Six Minutes Walking Test, while significant differences were only evident at 3 months for the VAS assessment of pain and for the radiographic appearance. The aim of the study was also to look for a correlation between clinical efficacy and post-stimulation change of bone structure; for this reason, in addition to analyzing the clinical effect, an assessment was carried out on the hip-bone level, radius, and tibia effects on bone mass and microstructure. After 1 month and 3 months, there was a marked improvement in the quality of life of the patients, but there was no increase in bone density at the level of the examined portions. It was used differently after 3 months, and there were changes to the bone microstructure.  
Finally, [PERSON] et al. concluded that PEMFs associated with multimodal management represent the gold standard in the treatment of vertebral compression fractures. This combined treatment improves patients' quality of life, promotes healing, and reduces the risks of undergoing surgery [33].