Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years

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Abstract

Study Design:

Prospective clinical study.

Objective:

Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years.

Methods:

A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery.

Results:

Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery ( P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery ( P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks ( P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up.

Conclusions:

Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.

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Most cited references 36

Record: found
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Platelet-rich plasma: Growth factor enhancement for bone grafts.

R Marx, E R Carlson, R M Eichstaedt … (1998)

Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% +/- 11%) than in grafts in which platelet-rich plasma was not added (55.1% +/- 8%; p = 0.005).

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Article: not found

Iliac crest bone graft harvest donor site morbidity. A statistical evaluation.

Linda Asher, J C Banwart, R Hassanein (1995)

This study analyzed the cause, rate, and risk factors of iliac crest bone graft donor site morbidity. All complications or problems, no matter how small, were sought to develop strategies of prevention. A wide range of major, 0.76% (Keller et al) to 25% (Summers et al) and minor complications, 9.4% (Keller et al) to 24% (Summers et al) has been reported. A consecutive series of 261 patients, whose bone graft harvest was done by one surgeon, was studied by chart review and a mail survey that was not conducted by the operating surgeon. The survey presented specific open-ended questions designed to uncover any complication/problem, no matter how small. Complications then were categorized as major or minor and subcategorized as acute or chronic. Statistical analysis was done using chi-squared and multiple logistical regression. None of the 261 patients had a severe perioperative complication--e.g., superior gluteal artery injury, sciatic nerve injury, or deep wound infection. None of the 225 patients with long term follow-up (average, 66 months; range, 32-105 months) had a severe late complication--e.g., donor site herniation, meralgia paresthetica, pelvic instability, or fracture. Of the 180 patients meeting the qualifications for statistical analysis, major complications occurred in 18 (10%), only three of which affected function (pain). Minor complications occurred in 70 (39%). The results indicated that severe complications from iliac crest bone graft harvest can be avoided and major complications affecting functioning are uncommon, but minor complications are common. The findings suggest that procedural refinements of limiting subcutaneous dissection and providing layered tension-free incision closure may improve results.

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Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count.

Walter E. Hitzler, Gernot Weibrich, Wilfried K G Kleis … (2002)

Platelet-rich plasma contains autologous thrombocyte growth factors and might be promising for acceleration of dentoalveolar bone regeneration. In this study, it was analysed for platelet counts and growth factor concentrations. Platelet-rich plasma was isolated by discontinuous cell separation from 158 healthy men and 55 women aged 17-62 years. One hundred and fifteen specimens (stratified for age and gender of the donor) were analysed for growth factor concentrations and platelet count. The platelet count in platelet-rich plasma (1,407,640+/-320,100/microl) was 5 times higher than in donor blood (266,040+/-60,530/microl). Platelet-derived growth factor AB (117+/-63 ng/ml), transforming growth factor (TGF) beta -1 (169+/-84 ng/ml), and insulin-like growth factor (IGF) I (84+/-23 ng/ml) were found in large amounts, while platelet-derived growth factor (PDGF) BB (10+/-8 ng/ml) and transforming growth factor beta -2 (0.4+/-0.3 ng/ml) were found in small amounts only. The growth factor content was not well correlated with the platelet count in whole blood nor with the platelet-rich plasma (r(p)=0.35). No influence of gender or age on platelet count or growth factor concentrations was discovered (except IGF-I). While there was substantial variation in the growth factor content of platelet-rich plasma, the factors influencing this are still worthy of further investigation. Furthermore, a technique whereby the growth factor content could be rapidly assessed in platelet-rich plasma may be of therapeutic benefit. Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Global Spine J

Journal ID (iso-abbrev): Global Spine J

Journal ID (publisher-id): GSJ

Journal ID (hwp): spgsj

Title: Global Spine Journal

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 2192-5682

ISSN (Electronic): 2192-5690

Publication date (Electronic): 11 April 2017

Publication date (Print): December 2017

Volume: 7

Issue: 8

Pages: 749-755

Affiliations

[1 ]Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan

[2 ]Nakamura Orthopaedic Hospital, Ichinomiya, Aichi, Japan

[3 ]Japan Red Cross Tokai-Hokuriku Block Blood Center, Seto, Aichi, Japan

[4 ]Nagoya University Hospital, Department of Transfusion Medicine, Nagoya, Aichi, Japan

[5 ]Hamamatsu University School of Medicine, Department of Orthopaedic Surgery, Hamamatsu, Shizuoka, Japan

Author notes

[*]Shiro Imagama, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan. Email: imagama@ 123456med.nagoya-u.ac.jp

Article

Publisher ID: 10.1177_2192568217696690

DOI: 10.1177/2192568217696690

PMC ID: 5721988

SO-VID: 6ac13226-3a87-435b-8065-b4997cef664d

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years

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Abstract

Study Design:

Objective:

Methods:

Results:

Conclusions:

Related collections

50 years of ROAPE

Most cited references 36

Platelet-rich plasma: Growth factor enhancement for bone grafts.

Iliac crest bone graft harvest donor site morbidity. A statistical evaluation.

Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count.

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