Platelet-rich plasma in mono-segmental posterior lumbar interbody fusion

Abstract

Introduction The results of platelet-rich plasma (PRP) in spinal fusion applications are limited and controversial. Both beneficial and inhibitory effects have been shown. In this prospective randomised controlled trial, our objective was to assess both the clinical and radiologicaleffect of PRP when added to autograft iliac crest bone in posterior lumbar interbody fusion. Methods and materials Forty patients were recruited for the study fulfilling strict entry requirements and were randomised with a 1:1 ratio. In each group, one patient was lost to follow-up. Thirtyeight patients completed the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the Short-Form 36 (SF-36) preoperatively and postoperatively at 3, 6, 12, and 24 months, respectively. CT-scans of the lumbar spine were taken at 3, 6, and 12 months. Posterior stabilisation was achieved with pedicle screws and interbody fusion was aimed at with carbon cages filled with autologous bone. Results Baseline demographic data (age, sex, smoking history, preoperative outcome measures) showed no relevant difference between groups. For patients who received autograft only, the mean VAS improved by 4.0 points (p \ 0.01), mean ODI improved by 32.1 points (p \ 0.001), and mean SF-36 showed statistically significant improvement in each of the eight domains and in the physical (p \ 0.001) and mental (p \ 0.001) component summary measures. For patients who received autograft with PRP, the mean VAS improved by 4.92 points (p \ 0.01), mean ODI improved by 30 points (p \ 0.001), and mean SF-36 showed statistically significant improvement in six of the eight domains (p \ 0.02) and in the physical (p = 0.016) and mental (p \ 0.001) component summary measures. The improvement of the VAS score and the physical component summary score was more pronounced in patients who received autograft with PRP. These differences were, however, not statistically significant. CT-scans showed uneventful osseous healing in all but one patient with no difference between groups. Conclusion In this prospective randomised controlled clinical and radiological trial, adding PRP in posterior lumbar interbody fusion did not lead to a substantial improvement or deterioration when compared with autologous bone only. No inhibitory effect of PRP was observed on CT-scans. From a clinical and radiological point of view, the use of PRP seems to be justified in posterior lumbar interbody fusion surgery. From an economical point of view, the expense of using PRP cannot be justified until statistical significance can be reached in a larger study.

A Systematic Assessment of the Use of Platelet-Rich Plasma in Spinal Fusion

“…For example, Jenis et al 24 and Sys et al 54 assessed the effects of bone graft with PRP compared to bone graft alone and found no difference in fusion rates or clinical outcomes between the treatment groups. Tsai et al 56 likewise performed 1-level non-instrumented lumbar fusions and compared autograft with calcium sulfate and PRP to autograft and calcium sulfate alone, and found no significant difference in fusion rates.…”

“…1,5,8,9,15,18,19,24,34,37,[54][55][56][57]65 One study utilized an ACDF approach, one study studied posterior cervical fusions, six studies assessed thoracolumbar interbody grafts, and seven studies utilized a lumbar posterolateral fusion approach, including both instrumented and noninstrumented fusions. Most studies utilized commercially available systems for PRP preparation.…”

A Comparative Evaluation of Factors Influencing Osteoinductivity Among Scaffolds Designed for Bone Regeneration

“…[5][6][7][8][9][10][11] Other growth factors, such as platelet-rich plasma, have shown a limited efficacy in promoting healing. 12 While some preclinical studies have investigated the potential of allogeneic mesenchymal stem cell (MSC) therapy, efficacy concerns have thus far prevented its introduction into clinical practice. Although many ceramic-based bone graft substitutes have proven safe, because their osteoinductive capability is limited, bone healing can be suboptimal.…”

Regenerative Spinal Therapies for Low Back Pain

“…Carreon et al and Weiner et al [37,38] showed decreased rates of fusion with platelet gel when compared to bone graft alone with a 2-year follow-up. Sys et al [39] noted no improvement or deterioration with PRP compared to autograft alone at 24 months follow-up. Therefore, the role of PRP and platelet gel in spinal fusion is still controversial and uncertain at this time, with more studies needing to be done to determine if specific parameters exist in which it may be shown to have reproducible evidence for its benefit.…”