Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: a prospective randomized controlled trial

Publication date: Available online 20 July 2017
Source:The Spine Journal
Author(s): Go Kubota, Hiroto Kamoda, Sumihisa Orita, Kazuyo Yamauchi, Yoshihiro Sakuma, Yasuhiro Oikawa, Kazuhide Inage, Takeshi Sainoh, Jun Sato, Michihiro Ito, Masaomi Yamashita, Junichi Nakamura, Takane Suzuki, Kazuhisa Takahashi, Seiji Ohtori
Background ContextPlatelet-rich plasma (PRP) accelerates bone union in vivo in a rodent model of spinal fusion surgery. However, PRP's effect on bone union after spinal surgery remains unclear.PurposeTo evaluate the efficacy of PRP after posterolateral lumbar fusion (PLF) surgery.Study Design/SettingSingle-center prospective randomized controlled clinical trial with 2-year follow-up.Patient SampleTotal 62 patients (31 patients in PRP group or 31 patients in control groupsOutcome MeasuresBone fusion rate, area of bone fusion mass, duration for bone fusion, and clinical score using visual analog scale (VAS).MethodsWe randomized 62 patients who underwent one- or two-level instrumented PLF for lumbar degenerative spondylosis with instability to either PRP (31 patients) or control (31 patients) groups. PRP-treated patients underwent surgery using an autograft bone chip (local bone) and PRP was prepared from patient blood samples immediately before surgery; patients from the control group underwent PLF without PRP treatment. We assessed platelet counts and growth factor concentrations in PRP prepared immediately before surgery. Duration for bone union, postoperative bone fusion rate, and area of fusion mass were assessed using plain radiography every 3 months after surgery and by computed tomography (CT) at 12 or 24 months. The duration for bone fusion, and clinical scores for low back pain, leg pain, and leg numbness before, and 3, 6, 12, and 24 months after surgery were evaluated using a VAS.ResultsData from 50 patients with complete data were included. Bone union rate at final follow-up was significantly higher in the PRP group (94%) than controls (74%) (P = 0.002). Area of fusion mass was significantly higher in the PRP group (572 mm²) than controls (367 mm²) (P = 0.02). The mean period necessary for union was 7.8 months in the PRP group and 9.8 months in controls (P = 0.013). In the PRP, platelet count was 7.7 times higher and growth factor concentrations were 50 times higher than found in plasma (P < 0.05). There was no significant difference in low back pain, leg pain, and leg numbness in either group at any time evaluated (P > 0.05).ConclusionsPatients treated with PRP showed a higher fusion rate, greater fusion mass, and more rapid bone union after spinal fusion surgery than patients not treated with PRP.



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