Role of Platelet-Rich Plasma in Spinal Fusion Surgery: Systematic Review and Meta-Analysis

Abstract

Background. Platelet-rich plasma (PRP) has been used very successfully in enhancing bone fusion in animal experiments. Also, the efficaciousness of PRP in other specialties of medicine such as dentistry, dermatology ophthalmology, and sports medicine is well documented. But the use of PRP to augment bone fusion after spinal surgery in humans is still controversial. We conducted a meta-analysis to determine the role of PRP in enhancing spinal fusion by fastening the rate of new bone formation and decreasing pain after spinal surgery in humans. Methods. We searched PubMed, EMBASE, and the Cochrane Library studies that compared PRP versus control in enhancing spinal fusion after deformity correction. Results. Five retrospective studies with 253 participants and nine prospective cohort studies with 460 participants were identified. The bone fusion rate was excellent for studies that used a high platelet concentration in PRP relative to control (odds ratio (OR) = 4.35, 95% confidence interval (CI) (2.13, 8.83), and P<0.05) while bone fusion was poor to studies that used a low concentrate of platelet in PRP relative to control. The rate of new bone formation was high in the PRP group compared to the control group with the mean difference in Hounsfield unit (HU) 144.91 (95% CI (80.63, 209.18), P<0.05). Time to bone fusion was short in the PRP group during the first six months of surgery relative to the control group with a mean difference of −2.03 (95% CI (−2.35, −1.7); P<0.05). No difference was found in pain reduction by visual analog score (VAS) between the PRP group and control. Conclusion. PRP facilitates new bone formation and bone fusion with a minimum concentration of the growth factor 5 times that of the peripheral blood. PRP stimulatory effects are not continuous and are very effective within six months of implantation.

Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020

“…Through experimental and clinical research, we now have a better understanding of platelet and other cellular physiology. Furthermore, several high-quality systematic reviews, meta-analyses, and randomized controlled trials signify the effectiveness of PRP biotechnology in many medical fields, including dermatology [ 45 ], cardiac surgery [ 46 ], plastic surgery [ 47 ], orthopedic surgery [ 48 ], pain management [ 49 ], spinal disorders [ 50 ], and sports medicine [ 51 , 52 ].…”

Is Platelet-Rich Plasma Effective in Enhancing Spinal Fusion? Systematic Overview of Overlapping Meta-Analyses

“…Finally, 3 meta-analyses were included in this systematic overview. 19 - 21 These overlapping meta-analyses were published in different journals in 2020 and the number of included studies ranged from 11 to 14 as shown in Table 1 . The publication years of the included studies in these meta-analyses ranged between 2003 and 2019 as shown in Table 2 .…”

“…Recently, multiple meta-analyses have been published in this regard analyzing the effectiveness of PRP in enhancing spinal fusion. 19 - 21 However, these overlapping meta-analyses further added to the controversy due to their inconsistent results and conflicting conclusions because of the variability in the primary studies included for meta-analysis. Every meta-analysis suffered from a limited pooled sample size.…”

Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

“…PRP is a concentrate of platelets and other growth factors, which have been implicated as a potent biomaterial in regenerative medicine. In the PRP, the presence of platelet-derived biomaterials (PDB) such as epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), epithelial cell growth factor (EGR), hepatocyte growth factor (HGF), insulin-like growth factor (IGF), platelet-derived growth factor (PDGF), platelet-derived angiogenesis factor (PDAF), platelet factor-4 (PF-4), transforming growth factor (TGF), Il-1, IL-6, and TNF-α have been reported to initiate and participate in the progression of bone fusion and healing [ 215 , 216 ]. Recent pre-clinical and clinical studies have also implicated the potential of PRP in promoting bone fusion during lumbar infusion surgeries.…”

“…However, a systemic review and meta-analysis concluded that PRP could not contribute significantly in bone fusion as well as pain relief [ 223 ]. Although PRP-containing growth factors possess the potential to induce bone formation and fusion, the lack of a continuous pattern limits reaching a clear consensus [ 215 ]. Consequently, combined strategies of PRP and MIS-TLIF need to be explored to establish its therapeutic potential.…”