The impact of platelet-rich plasma on postoperative outcomes after spinal fusion: a systematic review and meta-analysis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Platelet-rich plasma (PRP) is a biological agent obtained by centrifuging a sample of blood and retrieving a high concentration of platelets and plasma components. The concentrate is then stimulated for platelet secretion of various growth factors and cytokines. Although it is not widely used in clinical practice, its role in augmenting bony union among patients undergoing spinal fusion has been assessed in several clinical studies. The objective of this study was to perform a systematic review and meta-analysis of the existing literature to determine the efficacy of PRP use in spinal fusion procedures.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A comprehensive literature search was conducted using PubMed, Scopus, and EMBASE for studies from all available dates. From eligible studies, data regarding the fusion rate and method of assessing fusion, estimated blood loss (EBL), and baseline and final visual analog scale (VAS) scores were collected as the primary outcomes of interest. Patients were grouped by those undergoing spinal fusion with PRP and bone graft (PRP group) and those only with bone graft (graft-only group).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The literature search resulted in 207 articles. Forty-five full-text articles were screened, of which 11 studies were included, resulting in a meta-analysis including 741 patients. Patients without PRP were more likely to have a successful fusion at the last follow-up compared with those with PRP in their bone grafts (OR 0.53, 95% CI 0.34–0.84; p = 0.006). There was no statistically significant difference with regard to change in VAS scores (OR 0.00, 95% CI −2.84 to 2.84; p &gt; 0.99) or change in EBL (OR 3.67, 95% CI −67.13–74.48; p = 0.92) between the groups.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study found that the additional use of PRP was not associated with any significant improvement in patient-reported outcomes and was actually found to be associated with lower fusion rates compared with standard grafting techniques. Thus, PRP may have a limited role in augmenting spinal fusion.</jats:p></jats:sec>

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

“…Eventually, we identified the meta-analysis by YU Yolcu et al 21 as the highest-quality study among the included meta-analysis based on the Jadad decision algorithm. This study has shown that the utilization of PRP was not associated with significant improvement in patient-reported outcomes such as Visual Analog Score for pain compared to the standard fusion procedure.…”

“…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 .…”

“…Two of the 3 included studies analyzed possible publication bias. 20,21 As shown in Table 5, the AMSTAR scores of the included studies ranged from 5 to 8 (mean 6.3).…”

“…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.…”

Efficacy of Platelet-rich Plasma Impregnation for Unidirectional Porous Β-tricalcium Phosphate in Lateral Lumbar Interbody Fusion: Study Protocol for a Randomized Controlled Trial

“…Platelet-rich plasma (PRP) is a blood plasma containing concentrated autologous platelets with several growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β), and insulin-like growth factor (IGF) [5,6,7]. Therefore, PRP has been used to accelerate bone and soft tissue healing not only in oral dentistry, dermatology, ophthalmology, and sports medicine, but also in spinal fusion surgery [8,9,10,11,12].…”