European Spine Journal

, 20:1650 | Cite as

Platelet-rich plasma in mono-segmental posterior lumbar interbody fusion

  • J. SysEmail author
  • J. Weyler
  • T. Van Der Zijden
  • P. Parizel
  • J. Michielsen
Original Article



The results of platelet-rich plasma (PRP) in spinal fusion applications are limited and controversial. Both beneficial and inhibitory effects have been shown. In this prospective randomised controlled trial, our objective was to assess both the clinical and radiological effect of PRP when added to autograft iliac crest bone in posterior lumbar interbody fusion.

Methods and materials

Forty patients were recruited for the study fulfilling strict entry requirements and were randomised with a 1:1 ratio. In each group, one patient was lost to follow-up. Thirtyeight patients completed the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the Short-Form 36 (SF-36) preoperatively and postoperatively at 3, 6, 12, and 24 months, respectively. CT-scans of the lumbar spine were taken at 3, 6, and 12 months. Posterior stabilisation was achieved with pedicle screws and interbody fusion was aimed at with carbon cages filled with autologous bone.


Baseline demographic data (age, sex, smoking history, preoperative outcome measures) showed no relevant difference between groups. For patients who received autograft only, the mean VAS improved by 4.0 points (p < 0.01), mean ODI improved by 32.1 points (p < 0.001), and mean SF-36 showed statistically significant improvement in each of the eight domains and in the physical (p < 0.001) and mental (p < 0.001) component summary measures. For patients who received autograft with PRP, the mean VAS improved by 4.92 points (p < 0.01), mean ODI improved by 30 points (p < 0.001), and mean SF-36 showed statistically significant improvement in six of the eight domains (p < 0.02) and in the physical (p = 0.016) and mental (p < 0.001) component summary measures. The improvement of the VAS score and the physical component summary score was more pronounced in patients who received autograft with PRP. These differences were, however, not statistically significant. CT-scans showed uneventful osseous healing in all but one patient with no difference between groups.


In this prospective randomised controlled clinical and radiological trial, adding PRP in posterior lumbar interbody fusion did not lead to a substantial improvement or deterioration when compared with autologous bone only. No inhibitory effect of PRP was observed on CT-scans. From a clinical and radiological point of view, the use of PRP seems to be justified in posterior lumbar interbody fusion surgery. From an economical point of view, the expense of using PRP cannot be justified until statistical significance can be reached in a larger study.


Lumbar spine Fusion Platelet-rich plasma Randomised controlled trial 


Conflict of interest

The reviewers and the surgeon have and had no personal or financial interest in companies selling AGF- or PRP-technology, nor have they received any financial support from them.


  1. 1.
    Archundia TR, Soriano JC, Corona JN (2007) Utility of platelet-rich plasma and growth factors in bone defects. Act Orthop MexicanaGoogle Scholar
  2. 2.
    Arm DM, Lowery GL, Hood AG Characterization of an autologous platelet gel containing multiple growth factors. Presented at the 45th Orthopaedic Research Society meeting, AnaheimGoogle Scholar
  3. 3.
    Arpornmaeklong P, Kochel M, Depprich R, Kubler NR, Wurzler KK (1999) Influence of platelet-rich plasma (PRP) on osteogenic differentiation of rat bone marrow stromal cells. An in vitro study. Int J Oral Maxillofac Surg 33:60–70CrossRefGoogle Scholar
  4. 4.
    Aspenberg P, Jeppsson C, Wang JS, Bostrom M (1996) Transforming growth factor beta and bone morphogenetic protein 2 for bone ingrowth: a comparison using bone chambers in rats. Bone 19:499–503PubMedCrossRefGoogle Scholar
  5. 5.
    Bose B, Balzarini MA (2002) Bone graft gel: autologous growth factors in lumbar spine fusions. Adv Ther 19:170–175PubMedCrossRefGoogle Scholar
  6. 6.
    Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM (1996) Lumbar interbody fusion using the Brantigan I/F cage for PLIF and the VSP pedicle screw system: two-year results of a Food and Drug Administration IDE clinical trial. In: Hudson, LeHuec JC (eds) Intersomatique du Rachis Lumbaire, Montpellier, France, Sauramps MedicalGoogle Scholar
  7. 7.
    Butterfield KJ, Bennett J, Gronowicz G, Adams D (2005) Effect of platelet-rich plasma with autogenous bone graft for maxillary sinus augmentation in a rabbit model. J Oral Maxillofac Surg 63:370–376PubMedCrossRefGoogle Scholar
  8. 8.
    Carreon LY, Glassman SD, Anekstein Y, Puno RM (2005) Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions. Spine 30:E243–E247PubMedCrossRefGoogle Scholar
  9. 9.
    Castro FP Jr (2004) Role of activated growth factors in lumbar spinal fusions. J Spinal Disord Tech 17:380–384PubMedCrossRefGoogle Scholar
  10. 10.
    Cenni E, Ciapetti G, Pagani S, Perut F, Giunti A, Baldini N (2005) Effects of activated platelet concentrates on human primary cultures of fibroblasts and osteoblasts. J Periodontol 76:323–328PubMedCrossRefGoogle Scholar
  11. 11.
    Choi BH, Im CJ, Huh JY, Suh JJ, Lee SH (2004) Effect of platelet-rich plasma on bone regeneration in autogenous bone graft. Int J Oral Maxillofac Surg 33:56–59PubMedCrossRefGoogle Scholar
  12. 12.
    Cieslick-Bielecka A, Bielecki T, Gazdzik TS, Cieslik T, Szczepanski T (2008) Improved treatment of mandibular odontogenic cysts with platelet-rich gel. Oral Surg 105(4):423–429Google Scholar
  13. 13.
    Dori F, Nikolidakis D, Huszar T, Arweiler NB, Gera I, Sculean A (2008) Effect of platelet-rich plasma on the healing of intrabony defects treated with an enamel matrix protein derivative and a natural bone mineral. J Clin Periodont 35(1):44–50Google Scholar
  14. 14.
    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 31:615–619PubMedCrossRefGoogle Scholar
  15. 15.
    Eppley B, Woosell J, Higgins J (2004) Platelet quantification and growth factor analysis from platelet–rich plasma (PRP): implications in wound healing. Plastic Reconstruct Surgery 114:1502–1508CrossRefGoogle Scholar
  16. 16.
    Fairbank J, Pynsent B (2002) The Oswestry disability index. Spine 25:2940–2952CrossRefGoogle Scholar
  17. 17.
    Ferrara N, Houck K, Jakeman L, Leung D (1992) Molecular and biological properties of the vascular endothelial growth factor family of proteins. Endocr Rev 13:18–32PubMedGoogle Scholar
  18. 18.
    Fraser RD (1995) Interbody, posterior, and combined lumbar fusions. Spine 90(24S):167S–177SCrossRefGoogle Scholar
  19. 19.
    Hannon T, Polston G, Petarske W et al (1996) Determination of platelet yields from platelet rich plasma for five autotransfusion machines. Anaesth Analg 88:104–109Google Scholar
  20. 20.
    Hee HT, Majd ME, Holt RT, Myers L (2003) Do autologous growth factors enhance transforaminal lumbar interbody fusion? Eur Spine J 12:400–407PubMedCrossRefGoogle Scholar
  21. 21.
    Jenis LG, Banco RJ, Kwon B (2006) A prospective study of autologous growth factors in lumbar interbody fusion. Spine J 6:14–20PubMedCrossRefGoogle Scholar
  22. 22.
    Kevy S, Jacobson M (2004) Comparison of methods for point of care preparation of autologous platelet gel. J Extra Corp Technol 36:28–35Google Scholar
  23. 23.
    Kumar A, Kozak JA, Doherty BJ, Dickson JH (1993) Interspace distraction and graft subsidence after anterior lumbar fusion with femoral strut allograft. Spine 18:2393–2400PubMedCrossRefGoogle Scholar
  24. 24.
    Lind M, Deleuran B, Thestrup-Pedersen K et al (1995) Chemotaxis of human osteoblasts. Effect of osteotropic growth factors. APMIS 103:140–146PubMedCrossRefGoogle Scholar
  25. 25.
    Lowery GL, Kulkarni S, Pennisi AE (1999) Use of autologous growth factors in lumbar spinal fusion. Bone 25(2 Suppl):47S–50SPubMedCrossRefGoogle Scholar
  26. 26.
    Marx RE (2001) Platelat-rich Plasma: what is PRP and what is not PRP? Implant Dent 10:225–228PubMedCrossRefGoogle Scholar
  27. 27.
    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 85:638–646PubMedCrossRefGoogle Scholar
  28. 28.
    Mc Afee PC (1999) Current concepts review: interbody fusion cages in reconstructive operations of the spine. J Bone Joint Surg Am 81:859–880Google Scholar
  29. 29.
    Mehta S, Watson JT (2008) Platelet rich concentrate: basic science and current clinical applications. JOT 22(6):432–438Google Scholar
  30. 30.
    Miyazaki M, Tsumura H, Wang JC, Alanay A (2009) An update on bone substitutes for spinal fusion. Eur Spine J 6:783–799CrossRefGoogle Scholar
  31. 31.
    Obremskey WT, Marotta JS, Yaszemski MJ, Churchill LR, Boden SD, Dirschl DR. The introduction of biologics in orthopaedics: issues of cost, commercialism, and ethics. J Bone Joint Surg Am 89:1641–1649Google Scholar
  32. 32.
    Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB (1995) Assessing health-related quality of life in patients with sciatica. Spine 20:1899–1908PubMedCrossRefGoogle Scholar
  33. 33.
    Ranly DM, McMillan J, Keller T, Lohmann CH, Meunch T, Cochran DL, Schwartz Z, Boyan BD (2005) Platelet-derived growth factor inhibits demineralized bone matrix-induced intramuscular cartilage and bone formation. A study of immunocompromised mice. J Bone Joint Surg Am 287:2052–2064CrossRefGoogle Scholar
  34. 34.
    Schaaf H, Strekbein P, Lendeckel S, Heidinger K, Gortz B, Bein G, Boedecker RH, Schlegel KA, Howalt HP (2008) Topical use of platelet-rich plasma to influence bone volume in maxillary augmentation: a prospective randomized trial. Vox Sang 94(1):64–69PubMedGoogle Scholar
  35. 35.
    Ware J, Sherbourne C (1992) The MOS 36 Item Short Form Health Survey (SF36). Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  36. 36.
    Ware JE, Kosinski M, Bjorner JB, Turner-Bowker DM, Gandek B, Maruish ME (2007) User’s Manual fot the SF-36v2® Health Survey, 2nd edn. QualityMetric Incorporated, LincolnGoogle Scholar
  37. 37.
    Weiner BK, Walker M (2003) Efficacy of autologous growth factors in lumbar intertransverse fusions. Spine 28:1968–1971PubMedCrossRefGoogle Scholar
  38. 38.
    Whitman DH, Berry RL, Green DM (1997) Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg 55:1294–1299PubMedCrossRefGoogle Scholar
  39. 39.
    Zimmerman R, Jacubietz R, Jacubiets M et al (2002) Different preparation methods to obtain platelet components as a source of growth factors for local application. Transfusion 41:1217–1224CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • J. Sys
    • 1
    Email author
  • J. Weyler
    • 2
  • T. Van Der Zijden
    • 3
  • P. Parizel
    • 3
  • J. Michielsen
    • 4
  1. 1.Department of Orthopaedics and TraumatologySint Basius HospitalDendermondeBelgium
  2. 2.Department of Epidemiology and Social MedicineUniversity of AntwerpAntwerpBelgium
  3. 3.Department of RadiologyUniversity Hospital of AntwerpAntwerpBelgium
  4. 4.Department of Orthopaedics and TraumatologyUniversity Hospital of AntwerpAntwerpBelgium

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