Platelet-Rich Plasma-A Safe and Cost-effective Dural Sealant in Spinal Surgeries-A Systematic Review

Abstract

Introduction Incidental durotomy (ID) is a common complication of otherwise rewarding lumbar decompression surgeries. An effective water-tight closure of the dura can potentially avoid cerebrospinal fluid (CSF) leakage and its dreaded sequel. Several sealants, grafts, and patches are used; however, the cost constrains its utility in resource-limited settings. Platelet-rich plasma (PRP) has been found effective in wound healing and adhesive properties and hence a potential adjunct for watertight closure of dura. This systematic review was conducted to highlight the existing literature on the utility of PRP in spinal procedures for the managing of CSF leaks. Methods The review was conducted based on the PRISMA guidelines. After a comprehensive database search through three databases (PubMed, Scopus, and Cochrane Library), studies assessing the role of PRP in CSF leaks or for the water-tight closure of dura were included. The study descriptions, demographic details, methodology, and outcomes were assessed. Results A total of six studies were included. In vitro studies and animal trials demonstrated the efficacy of PRP in achieving watertight dural closure and prevention of CSF leaks when standard suturing techniques failed. PRP application in rat models have been shown to cause increased dura mater thickness and enhanced vascularity. Clinical cases revealed mixed outcomes, with some patients experiencing symptom relief and improved radiological findings after PRP interventions, while a minority faced recurrent symptoms. Conclusion PRP is a promising tool to achieve water-tight dural closure. Although the clinical evidence is limited at this juncture, its feasibility, cost-effectiveness, and safety profile make it suitable for initiating clinical trials to assess its optimal clinical application.