Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

PLF:

Posterolateral lumbar fusion

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

UMD:

Unstandardized mean difference

VAS:

Visual analog score

CI:

Confidence interval

BMP:

Bone morphogenic protein

PRP:

Platelet-rich plasma

SD:

Standard deviation

RCT:

Randomized controlled trial

OR:

Odds ratio

References

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

    Article  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  3. 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):461–472

    Article  CAS  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. 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):455–463

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  9. 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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):802–808

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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):e1000100

    Article  Google Scholar 

  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):140–146

    PubMed  CAS  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  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):991–996

    Article  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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–S81

    Article  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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

    Article  Google Scholar 

  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):1179–1184

    Article  Google Scholar 

  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

    Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

All authors declare no funding source or sponsor involvement in the study design, collection, analysis and interpretation of the data, in writing the manuscript, and in submission of the manuscript for publication.

Funding

This study has no funding support.

Author information

Authors and Affiliations

  1. Orthopedics Department, Queen Savang Vadhana Memorial Hospital, Sriracha, Cholburi, Thailand

    Saran Pairuchvej

  2. Mater Dei School, Bangkok, Thailand

    Janisa Andrea Muljadi

  3. Orthopedics Department, Lerdsin General Hospital, Bangkok, Thailand

    Alisara Arirachakaran

  4. Section for Sport and Orthopedic Center, Samitivej Hospital, Bangkok, Thailand

    Jatupon Kongtharvonskul

Authors
  1. Saran Pairuchvej
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janisa Andrea Muljadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alisara Arirachakaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jatupon Kongtharvonskul
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SP was responsible for the conception and design, collection and assembly of data, analysis and interpretation of the data, drafting of the manuscript, final approval of the article. JM was responsible for the conception and design, collection and assembly of data, critical revision of the manuscript for important intellectual content, final approval of the article. AA was responsible for manuscript writing, critical revision of the manuscript for important intellectual contents, final approval of the article. JK was responsible for the conception and design, collection and assembly of data, supervise in analysis and interpretation of the data, writing the manuscript, critical revision of the manuscript for important intellectual contents, final approval of the article, statistical expertise.

Corresponding author

Correspondence to Jatupon Kongtharvonskul.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interests.

Ethical standards

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pairuchvej, S., Muljadi, J.A., Arirachakaran, A. et al. Efficacy of platelet-rich plasma in posterior lumbar interbody fusion: systematic review and meta-analysis. Eur J Orthop Surg Traumatol 30, 583–593 (2020). https://doi.org/10.1007/s00590-019-02603-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02603-3

Keywords

Search

Navigation