Posterolateral Arthrodesis in Lumbar Spine Surgery Using Autologous Platelet-Rich Plasma and Cancellous Bone Substitute: An Osteoinductive and Osteoconductive Effect

Abstract

Study Design Prospective cohort study. Objectives To analyze the effectiveness and practicality of using cancellous bone substitute with platelet-rich plasma (PRP) in posterolateral arthrodesis. Methods Twenty consecutive patients underwent posterolateral arthrodesis with implantation of cancellous bone substitute soaked with PRP obtained directly in the operating theater on the right hemifield and cancellous bone substitute soaked with saline solution on the right. Results Computed tomography scans at 6 and 12 months after surgery were performed in all patients. Bone density was investigated by comparative analysis of region of interest. The data were analyzed with repeated-measures variance analyses with value of density after 6 months and value of density after 12 months, using age, levels of arthrodesis, and platelet count as covariates. The data demonstrated increased bone density using PRP and heterologous cancellous block resulting in an enhanced fusion rate during the first 6 months after surgery. Conclusions PRP used with cancellous bone substitute increases the rate of fusion and bone density joining osteoinductive and osteoconductive effect.

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

“…Only a few studies reported the volume of PRP and/or bone graft obtained and used, with reports of up to 60 cc of PRP obtained from each patient, 9,37 and 4.5-20 cc of PRP used in conjunction with bone graft. 24,55 The wide variation observed in clinical fusion results makes it challenging to draw conclusions regarding the ideal amount or ratio of PRP to bone graft for the different fusion techniques. The choice of bone graft or bone graft extender may also have significant effects on clinical results, as they also used growth factor carriers in many of the PRP studies.…”

“…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.…”

The Effects of the Combined Use of Platelet-Rich Plasma and Xenograft on Alveolar Socket Healing

“…Some studies have been conducted to verify the effectiveness of PRP also in combination with different bone substitutes. These studies have found that PRP combined with autogenous bone provides considerably faster bone regeneration results, radiographic and histomorphometrically, besides indicating denser bone [35].Variable successful results have been demonstrated when the PRP is added to an allograft [36]. Alissa et al [37], in a pilot study on the effect of PRP on the healing of extraction sockets, reported a significantly improved soft tissue healing in patients treated with PRP compared with those of the control group (no treatment).…”

“…Nevertheless, to achieve optimal results, all grafts require adequate blood supply, mechanical support, and osteogenic cells supplied by the host [34]. It was reported by Kotsakis et al [35] anhigher alveolar bone preservation of human sockets if filled with blood clot and anorganic bovine bone, when compared to blood clot and bioactive glass ceramics. The employment of platelet-rich plasma (PRP) constitutes a relatively innovative technique to improve bone healing.…”

Use of Platelet-Rich Plasma to Reinforce the Staple Line During Laparoscopic Sleeve Gastrectomy: Feasibility Study and Preliminary Outcome

“…19,20 The use of PRP is still validated in several surgical branches (periodontal and oral, maxillofacial, orthopedic, plastic, spinal, and cardiac) and in the management of diabetic wounds and burns. [27][28][29][30][31][32][33][34][35][36][37][38] The significance behind its use refers to the abundance of GFs stored in platelets, which enhance the quality of wound healing and reduce healing times by expediting tissue regeneration. In particular, platelet-derived GF, transforming GF, vascular endothelial GF, insulin-like GF, platelet-derived angiogenic factor, and epithelial GF play key roles in the healing process.…”