European Spine Journal

, Volume 28, Issue 4, pp 719–726 | Cite as

Single-center, consecutive series study of the use of a novel platelet-rich fibrin matrix (PRFM) and beta-tricalcium phosphate in posterolateral lumbar fusion

  • Tucker C. CallananEmail author
  • Antonio T. Brecevich
  • Craig D. Steiner
  • Fred Xavier
  • Justin A. Iorio
  • Celeste Abjornson
  • Frank P. Cammisa
Original Article



To evaluate the radiographic and clinical outcomes of the combination of platelet-rich fibrin matrix (PRFM) with beta-tricalcium phosphate (β-TCP) and bone marrow aspirate (BMA) as a graft alternative in posterolateral lumbar fusion procedures.


Researchers evaluated 50 consecutive patients undergoing one-level to three-level posterolateral lumbar fusion procedures, resulting in a total of 66 operated levels. The primary outcome was evidence of radiographic fusion at 1-year follow-up, assessed by three independent evaluators using the Lenke scoring system. Secondary outcomes included back and leg VAS scores, incidence of reoperations and complications, return-to-work status, and opioid use.


At 1-year follow-up, radiographic fusion was observed in 92.4% (61/66) of operated levels. There was significant improvement in VAS scores for both back and leg pain (p < 0.05). Compared to baseline figures, the number of patients using opioid analgesics at 12-months decreased by 38%. The majority (31/50) of patients were retired, yet 68% of employed patients (n = 19) were able to return to work. No surgical site infections were noted, and no revision surgery at the operated level was required.


This is the first report to analyze the combination of PRFM with β-TCP and BMA for PLF procedures. Our results indicate a rate of fusion similar to those reported using iliac crest bone graft (ICBG), while avoiding donor site morbidity related to ICBG harvesting such as hematoma, pain, and infection.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Platelet-rich fibrin matrix Posterolateral lumbar fusion Beta-tricalcium phosphate Bone marrow aspirate Bone graft substitute 


Compliance with ethical standards

Conflict of interest

Dr. Antonio Brecevich discloses consulting and stock options from Vertical Spine. Dr. Justin Iorio discloses consulting and royalties from Medicrea. Dr. Frank Cammisa discloses stock options from Vertical Spine and research support from Integra Life Sciences. Dr. Celeste Abjornson discloses research support from Integra Life Sciences. For the remaining authors, no potential conflict of interests were declared. This study was approved by the Hospital for Special Surgery’s Institutional Review Board (IRB).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

Supplementary material

586_2018_5832_MOESM1_ESM.pptx (2.5 mb)
Supplementary material 1 (PPTX 2575 kb)


  1. 1.
    Rajaee SS, Bae HW, Kanim LEA, Delamarter RB (2012) Spinal fusion in the United States. Spine 37:67–76. CrossRefGoogle Scholar
  2. 2.
    Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:1055–1060CrossRefGoogle Scholar
  3. 3.
    Tuchman A, Brodke DS, Youssef JA et al (2016) Iliac crest bone graft versus local autograft or allograft for lumbar spinal fusion: a systematic review. Glob Spine J 6:592–606. CrossRefGoogle Scholar
  4. 4.
    Khan SN, Cammisa FP, Sandhu HS et al (2005) The biology of bone grafting. J Am Acad Orthop Surg 13:77–86CrossRefGoogle Scholar
  5. 5.
    Grabowski G, Cornett CA (2013) Bone graft and bone graft substitutes in spine surgery: current concepts and controversies. J Am Acad Orthop Surg 21:51–60. CrossRefGoogle Scholar
  6. 6.
    Alsaleh KAM, Tougas CA, Roffey DM, Wai EK (2012) Osteoconductive bone graft extenders in posterolateral thoracolumbar spinal fusion. Spine 37:E993–E1000. CrossRefGoogle Scholar
  7. 7.
    Wu C, Chang J, Xiao Y (2013) Advanced bioactive inorganic materials for bone regeneration and drug delivery. CRC Press/Taylor & Francis GroupGoogle Scholar
  8. 8.
    Greenwald AS, Boden SD, Goldberg VM et al (2001) Bone-graft substitutes: facts, fictions, and applications. J Bone Joint Surg Am 83–A:Suppl:98–103. Google Scholar
  9. 9.
    Lucarelli E, Beretta R, Dozza B et al (2010) A recently developed bifacial platelet-rich fibrin matrix. Eur Cells Mater 20:13–23. CrossRefGoogle Scholar
  10. 10.
    Lenke LG, Bridwell KH, Bullis D et al (1992) Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord 5:433–442CrossRefGoogle Scholar
  11. 11.
    Alsousou J, Thompson M, Hulley P et al (2009) The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br 91:987–996. CrossRefGoogle Scholar
  12. 12.
    Kubota G, Kamoda H, Orita S et al (2017) Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: A prospective randomized controlled trial. Spine J. Google Scholar
  13. 13.
    Elder BD, Holmes C, Goodwin CR et al (2015) A systematic assessment of the use of platelet-rich plasma in spinal fusion. Ann Biomed Eng 43:1057–1070. CrossRefGoogle Scholar
  14. 14.
    Choukroun J, Adda F, Schoeffler C, Vervelle A (2001) Une opportunité en paro-implantologie: Le PRF. Implantodontie 55–62Google Scholar
  15. 15.
    Verma UP, Yadav RK, Dixit M, Gupta A (2017) Platelet-rich fibrin: a paradigm in periodontal therapy—a systematic review. J Int Soc Prev Community Dent 7:227–233. Google Scholar
  16. 16.
    Kang Y-H, Jeon SH, Park J-Y et al (2011) Platelet-rich fibrin is a bioscaffold and reservoir of growth factors for tissue regeneration. Tissue Eng Part A 17:349–359. CrossRefGoogle Scholar
  17. 17.
    Dohan Ehrenfest DM, Bielecki T, Jimbo R et al (2012) 15-Do the fibrin architecture and leukocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a pure platelet-rich plasma (P-PRP) gel and a leukocyte- and platelet-rich fibrin (L-PRF). Curr Pharm Biotechnol 13:1145–1152. CrossRefGoogle Scholar
  18. 18.
    Roy S, Driggs J, Elgharably H et al (2011) Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair Regen 19:753–766. CrossRefGoogle Scholar
  19. 19.
    Visser LC, Arnoczky SP, Caballero O, Egerbacher M (2010) Platelet-rich fibrin constructs elute higher concentrations of transforming growth factor-β1 and increase tendon cell proliferation over time when compared to blood clots: a comparative in vitro analysis. Vet Surg 39:811–817. CrossRefGoogle Scholar
  20. 20.
    Vadalà G, Di Martino A, Tirindelli MC et al (2008) Use of autologous bone marrow cells concentrate enriched with platelet-rich fibrin on corticocancellous bone allograft for posterolateral multilevel cervical fusion. J Tissue Eng Regen Med 2:515–520. CrossRefGoogle Scholar
  21. 21.
    Nagineni VV, James AR, Alimi M et al (2012) Silicate-substituted calcium phosphate ceramic bone graft replacement for spinal fusion procedures. Spine 37:E1264–E1272. CrossRefGoogle Scholar
  22. 22.
    Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. Spine 35:E1058–E1063. CrossRefGoogle Scholar
  23. 23.
    Carreon LY, Glassman SD, Djurasovic M (2007) Reliability and agreement between fine-cut CT scans and plain radiography in the evaluation of posterolateral fusions. Spine J 7:39–43. CrossRefGoogle Scholar
  24. 24.
    Jenis LG, Banco RJ, Kwon B (2006) A prospective study of Autologous Growth Factors (AGF) in lumbar interbody fusion. Spine J 6:14–20. CrossRefGoogle Scholar
  25. 25.
    Ajiboye RM, Eckardt MA, Hamamoto JT et al (2016) Outcomes of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusion. Int J Spine Surg 10(2):35. 10.14444/3035Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hospital for Special SurgeryNew YorkUSA
  2. 2.Hospital for Special SurgeryNew YorkUSA

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