Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-05-2020 | Back Pain | Original Article

Efficacy of platelet-rich plasma in posterior lumbar interbody fusion: systematic review and meta-analysis

Authors: Saran Pairuchvej, Janisa Andrea Muljadi, Alisara Arirachakaran, Jatupon Kongtharvonskul

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 4/2020

Abstract

Introduction

We have conducted a systematic review and meta-analysis that aims to compare outcomes (pain VAS, fusion and adverse event) of PRP and placebo after posterolateral lumbar fusion (PLF) surgery.

Materials and methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were identified from Medline and Scopus from inception to September 16, 2019 that reported visual analog scale back pain, postoperative complications and fusions of either group.

Results

In a total of seven studies, two, two, three studies were RCT, prospective and retrospective studies, respectively. Overall, there were 270 patients (150 in the PRP group and 149 in the placebo group). Three, three, four, three, two, seven and four studies were reported for pain VAS back in 3 months, 6 months, 12 months, 24 months, period of fusion, postoperative fusion and adverse events, respectively. The unstandardized mean difference (UMD) VAS back in 3, 6, 6 and 24 months was − 0.41 (95% CI − 0.87, 0.05) score, − 0.97 (95% CI − 1.68, − 0.27) score, − 0.33 (95% CI − 0.61, − 0.59) score, − 0.19 (95% CI − 1.00, 0.62) scores lower than placebo after posterolateral lumbar fusion (PLF) patients. The UMD period of bone union were − 1.62 (95% CI − 1.85, − 1.39) months faster than placebo after PLF patients. A total of seven and four studies were reported fusion and adverse events between PRP and placebo group. No significant differences were noted for fusion and adverse events with the pooled RR of 1.03 (95% CI 0.48, 1.80) and 0.95 (95% CI 0.14, 6.56).

Conclusions

PRP with autologous bone graft had lower back pain and faster bone union time than bone graft alone. While, there have no difference in fusion rate and adverse events in both groups. Larger, prospective randomized controlled studies are needed to confirm these findings as the current literature is still insufficient. Further research including cost of operation, postoperative function and satisfaction, quality of life and cost-efficacy analysis is required to determine whether the PRP with autologous bone graft is superior to bone graft alone or not.

Level of evidence

Level II.

Bose B, Balzarini MA (2002) Bone graft gel: autologous growth factors used with autograft bone for lumbar spine fusions. Adv Therapy 19(4):170–175CrossRef

Brew EC, Mitchell MB, Harken AH (1995) Fibroblast growth factors in operative wound healing. J Am Coll Surg 180(4):499–504PubMed

Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6(6):461–472CrossRef

Canalis E, McCarthy TL, Centrella M (1989) Effects of platelet-derived growth factor on bone formation in vitro. J Cell Physiol 140(3):530–537. https://doi.org/10.1002/jcp.1041400319 CrossRefPubMed

Cinotti G, Corsi A, Sacchetti B, Riminucci M, Bianco P, Giannicola G (2013) Bone ingrowth and vascular supply in experimental spinal fusion with platelet-rich plasma. Spine 38(5):385–391. https://doi.org/10.1097/BRS.0b013e31826dc6d4 CrossRefPubMed

Dugrillon A, Eichler H, Kern S, Kluter H (2002) Autologous concentrated platelet-rich plasma (cPRP) for local application in bone regeneration. Int J Oral Maxillofac Surg 31(6):615–619. https://doi.org/10.1054/ijom.2002.0322 CrossRefPubMed

Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463CrossRef

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634CrossRef

Ferrara N, Houck K, Jakeman L, Leung DW (1992) Molecular and biological properties of the vascular endothelial growth factor family of proteins. Endocr Rev 13(1):18–32. https://doi.org/10.1210/edrv-13-1-18 CrossRefPubMed

10.

Fischer CR, Cassilly R, Cantor W, Edusei E, Hammouri Q, Errico T (2013) A systematic review of comparative studies on bone graft alternatives for common spine fusion procedures. Eur Spine J 22(6):1423–1435. https://doi.org/10.1007/s00586-013-2718-4 CrossRefPubMedPubMedCentral

11.

Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22(24):2807–2812. https://doi.org/10.1097/00007632-199712150-00003 CrossRefPubMed

12.

France JC, Yaszemski MJ, Lauerman WC, Cain JE, Glover JM, Lawson KJ, Coe JD, Topper SM (1999) A randomized prospective study of posterolateral lumbar fusion. Outcomes with and without pedicle screw instrumentation. Spine 24(6):553–560. https://doi.org/10.1097/00007632-199903150-00010 CrossRefPubMed

13.

Gardner MJ, Demetrakopoulos D, Klepchick PR, Mooar PA (2007) The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty. An analysis of the haemoglobin, narcotic requirement and range of motion. International orthopaedics 31(3):309–313. https://doi.org/10.1007/s00264-006-0174-z CrossRefPubMed

14.

Hartmann EK, Heintel T, Morrison RH, Weckbach A (2010) Influence of platelet-rich plasma on the anterior fusion in spinal injuries: a qualitative and quantitative analysis using computer tomography. Arch Orthop Trauma Surg 130(7):909–914. https://doi.org/10.1007/s00402-009-1015-5 CrossRefPubMed

15.

Herkowitz HN, Kurz LT (1991) Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg 73(6):802–808CrossRef

16.

Hirano K, Matsuyama Y, Sakai Y, Katayama Y, Imagama S, Ito Z, Wakao N, Yoshihara H, Miura Y, Kamiya M, Sato K, Nakamura H, Ishiguro N (2010) Surgical complications and management of occipitothoracic fusion for cervical destructive lesions in RA patients. J Spinal Disord Tech 23(2):121–126. https://doi.org/10.1097/BSD.0b013e3181993315 CrossRefPubMed

17.

Imagama S, Ando K, Kobayashi K, Ishikawa Y, Nakamura H, Hida T, Ito K, Tsushima M, Matsumoto A, Morozumi M, Tanaka S, Machino M, Ota K, Nakashima H, Takamatsu J, Matsushita T, Nishida Y, Ishiguro N, Matsuyama Y (2017) Efficacy of early fusion with local bone graft and platelet-rich plasma in lumbar spinal fusion surgery followed over 10 years. Glob Spine J 7(8):749–755. https://doi.org/10.1177/2192568217696690 CrossRef

18.

Kamoda H, Ohtori S, Ishikawa T, Miyagi M, Arai G, Suzuki M, Sakuma Y, Oikawa Y, Kubota G, Orita S, Eguchi Y, Yamashita M, Yamauchi K, Inoue G, Hatano M, Takahashi K (2013) The effect of platelet-rich plasma on posterolateral lumbar fusion in a rat model. J Bone Joint Surg 95(12):1109–1116. https://doi.org/10.2106/jbjs.l.00320 CrossRefPubMed

19.

Kamoda H, Yamashita M, Ishikawa T, Miyagi M, Arai G, Suzuki M, Eguchi Y, Orita S, Sakuma Y, Oikawa Y, Inoue G, Ozawa T, Toyone T, Wada Y, Takahashi K, Ohtori S (2012) Platelet-rich plasma combined with hydroxyapatite for lumbar interbody fusion promoted bone formation and decreased an inflammatory pain neuropeptide in rats. Spine 37(20):1727–1733. https://doi.org/10.1097/BRS.0b013e31825567b7 CrossRefPubMed

20.

Knighton DR, Hunt TK, Thakral KK, Goodson WH 3rd (1982) Role of platelets and fibrin in the healing sequence: an in vivo study of angiogenesis and collagen synthesis. Ann Surg 196(4):379–388. https://doi.org/10.1097/00000658-198210000-00001 CrossRefPubMedPubMedCentral

21.

Kubota G, Kamoda H, Orita S, Inage K, Ito M, Yamashita M, Furuya T, Akazawa T, Shiga Y, Ohtori S (2018) Efficacy of platelet-rich plasma for bone fusion in transforaminal lumbar interbody fusion. Asian Spine J 12(1):112–118. https://doi.org/10.4184/asj.2018.12.1.112 CrossRefPubMedPubMedCentral

22.

Kubota G, Kamoda H, Orita S, Yamauchi K, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Sato J, Ito M, Yamashita M, Nakamura J, Suzuki T, Takahashi K, Ohtori S (2019) Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: a prospective randomized controlled trial. Spine J 19(2):e34–e40. https://doi.org/10.1016/j.spinee.2017.07.167 CrossRefPubMed

23.

Kurz LT, Garfin SR, Booth RE Jr (1989) Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14(12):1324–1331. https://doi.org/10.1097/00007632-198912000-00009 CrossRefPubMed

24.

Liao JC (2019) Positive effect on spinal fusion by the combination of platelet-rich plasma and collagen-mineral scaffold using lumbar posterolateral fusion model in rats. J Orthop Surg Res. https://doi.org/10.1186/s13018-019-1076-2 CrossRefPubMedPubMedCentral

25.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRef

26.

Lind M, Deleuran B, Thestrup-Pedersen K, Soballe K, Eriksen EF, Bunger C (1995) Chemotaxis of human osteoblasts. Effects of osteotropic growth factors. APMIS 103(2):140–146PubMed

27.

Liu Z, Zhu Y, Ge R, Zhu J, He X, Yuan X, Liu X (2017) Combination of bone marrow mesenchymal stem cells sheet and platelet rich plasma for posterolateral lumbar fusion. Oncotarget 8(37):62298–62311. https://doi.org/10.18632/oncotarget.19749 CrossRefPubMedPubMedCentral

28.

Lowery GL, Kulkarni S, Pennisi AE (1999) Use of autologous growth factors in lumbar spinal fusion. Bone 25(2 Suppl):47s–50s. https://doi.org/10.1016/s8756-3282(99)00132-5 CrossRefPubMed

29.

Marx RE (2001) Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 10(4):225–228CrossRef

30.

Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR (1998) Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85(6):638–646. https://doi.org/10.1016/s1079-2104(98)90029-4 CrossRefPubMed

31.

McGovern SC, Fong W, Wang JC (2010) Can bone morphogenetic protein binding peptide increase efficiency of bone formation? Spine 35(17):1655–1659. https://doi.org/10.1097/BRS.0b013e3181e83c93 CrossRefPubMed

32.

McGuire RA, Amundson GM (1993) The use of primary internal fixation in spondylolisthesis. Spine 18(12):1662–1672. https://doi.org/10.1097/00007632-199309000-00015 CrossRefPubMed

33.

Miyazaki M, Tsumura H, Wang JC, Alanay A (2009) An update on bone substitutes for spinal fusion. Eur Spine J 18(6):783–799. https://doi.org/10.1007/s00586-009-0924-x CrossRefPubMedPubMedCentral

34.

Noda M, Camilliere JJ (1989) In vivo stimulation of bone formation by transforming growth factor-beta. Endocrinology 124(6):2991–2994. https://doi.org/10.1210/endo-124-6-2991 CrossRefPubMed

35.

Palmer TM, Peter JL, Sutton AJ, Moreno SG (2008) Contour-enhanced funnel plots for meta-analysis. STATA J 8(2):242–254CrossRef

36.

Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61(10):991–996CrossRef

37.

Rezende CF, Azevedo DP, Lourenco RB, Duarte JF, Cardoso IM, Jacob Junior C (2017) Evaluation of the effectiveness of platelet-rich plasma in the bone consolidation of patients submitted to lumbar arthrodesis. Revista brasileira de ortopedia 52(6):693–698. https://doi.org/10.1016/j.rboe.2017.10.006 CrossRefPubMedPubMedCentral

38.

Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B (2010) Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. Am J Phys Med Rehabil 89(12):961–969. https://doi.org/10.1097/PHM.0b013e3181fc7edf CrossRefPubMed

39.

Sasso RC, LeHuec JC, Shaffrey C (2005) Iliac crest bone graft donor site pain after anterior lumbar interbody fusion: a prospective patient satisfaction outcome assessment. J Spinal Disord Tech 18(Suppl):S77–S81CrossRef

40.

StataCorp. (2017) Stata statistical software: Release 15. StataCorp LLC, College Station

41.

Steinmann JC, Herkowitz HN (1992) Pseudarthrosis of the spine. Clin Orthop Relat Res 284:80–90

42.

Sys J, Weyler J, Van Der Zijden T, Parizel P, Michielsen J (2011) Platelet-rich plasma in mono-segmental posterior lumbar interbody fusion. Eur Spine J 20(10):1650–1657. https://doi.org/10.1007/s00586-011-1897-0 CrossRefPubMedPubMedCentral

43.

Tsai CH, Hsu HC, Chen YJ, Lin MJ, Chen HT (2009) Using the growth factors-enriched platelet glue in spinal fusion and its efficiency. J Spinal Disord Tech 22(4):246–250. https://doi.org/10.1097/BSD.0b013e3181753ae2 CrossRef

44.

Wells GA SB, O’Connell D, Peterson J, Welch V, Losos M et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical/epidemiology/oxford.asp

45.

West JL 3rd, Bradford DS, Ogilvie JW (1991) Results of spinal arthrodesis with pedicle screw-plate fixation. J Bone Joint Surg 73(8):1179–1184CrossRef

46.

Zavadil DP, Satterlee CC, Costigan JM, Holt DW, Shostrom VK (2007) Autologous platelet gel and platelet-poor plasma reduce pain with total shoulder arthroplasty. J Extra-Corporeal Technol 39(3):177–182

47.

Zdeblick TA (1993) A prospective, randomized study of lumbar fusion. Preliminary results. Spine 18(8):983–991. https://doi.org/10.1097/00007632-199306150-00006 CrossRefPubMed

Title: Efficacy of platelet-rich plasma in posterior lumbar interbody fusion: systematic review and meta-analysis
Authors: Saran Pairuchvej
Janisa Andrea Muljadi
Alisara Arirachakaran
Jatupon Kongtharvonskul
Publication date: 01-05-2020
Publisher: Springer Paris
Keywords: Back Pain
Back Pain
Back Pain
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 4/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02603-3

At a glance: The STEP trials

Springer Medicine

Efficacy of platelet-rich plasma in posterior lumbar interbody fusion: systematic review and meta-analysis

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 4/2020

A new method for intraoperative assessment of leg length, sizing and placement of the components in total hip replacement

Bone integration in acetabular revision hip arthroplasty using equine-derived bone grafts: a retrospective study

Anterior acetabular retractors and the femoral neurovascular bundle in anterior total hip arthroplasty: a cadaveric study

The proton pump inhibitor, lansoprazole, prevents the development of non-traumatic osteonecrosis of the femoral head: an experimental and prospective clinical trial

Treatment of developmental dysplasia of the hip (DDH) between the age of 18 and 24 months

Widening is a predictive factor of bucket handle tear in tibial plateau fractures