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

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Abstract

Spinal fusion is one of the most commonly performed procedures for the treatment of spinal instability caused by a multitude of pathologies. However, despite significant advances in spinal instrumentation, failed fusion, or pseudoarthrosis, remains a significant challenge. Therefore, other additives such as bone graft extenders and growth factors have been explored as a method to augment fusion rates. Platelet-rich plasma (PRP) represents an additional approach, as it has shown some promise in bone regeneration. While the general use of PRP in orthopedic applications has been reviewed previously, its use in spinal fusion has not been systematically analyzed. The objective of this review is to systematically discuss the role of PRP in augmentation of bone regeneration for the purpose of spinal fusion. Background information on PRP, including a discussion of its preparation, activation, and growth factors, is included. Additionally, data from in vitro studies utilizing PRP in bone tissue engineering strategies is analyzed, and the available animal and clinical studies are systematically reviewed in order to provide guidance on future research pathways as well as the potential role of PRP in spinal fusion surgery.

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Abbreviations

ACDF:

Anterior cervical discectomy and fusion

ALIF:

Anterior lumbar interbody fusion

β-TCP:

Beta-tricalcium phosphate

CaCl2 :

Calcium chloride

CaCO3 :

Calcium carbonate

HA:

Hydroxyapatite

MSC:

Mesenchymal stem cell

PDGF:

Platelet-derived growth factor

PRP:

Platelet-rich plasma

rhBMP:

Recombinant human bone morphogenetic protein

TGF-β:

Transforming growth factor beta

TLIF:

Transforaminal lumbar interbody fusion

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Acknowledgments

This article reflects the views of the author and should not be construed to represent the US Food and Drug Administration’s views or policies.

Conflict of interest

The senior author (TW) has received prior donations of research materials from Eli Lily and Company for research indirectly related to the subject of this manuscript. Additionally, TW receives research support from the Gordon and Marilyn Macklin Foundation. No other benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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  1. Department of Neurosurgery, The Johns Hopkins Hospital, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA

    Benjamin D. Elder, Christina Holmes, C. Rory Goodwin, Sheng-Fu Lo, Varun Puvanesarajah, Thomas A. Kosztowski, John E. Locke & Timothy F. Witham

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  1. Benjamin D. Elder
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  2. Christina Holmes
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Associate Editor Eric M. Darling oversaw the review of this article.

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Elder, B.D., Holmes, C., Goodwin, C.R. et al. A Systematic Assessment of the Use of Platelet-Rich Plasma in Spinal Fusion. Ann Biomed Eng 43, 1057–1070 (2015). https://doi.org/10.1007/s10439-015-1300-0

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