Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years

Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Yoshimoto Ishikawa, Hiroshi Nakamura, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Junki Takamatsu, Tadashi Matsushita, Yoshihiro Nishida, Naoki Ishiguro, Yukihiro Matsuyama, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Yoshimoto Ishikawa, Hiroshi Nakamura, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Junki Takamatsu, Tadashi Matsushita, Yoshihiro Nishida, Naoki Ishiguro, Yukihiro Matsuyama

Abstract

Study design: Prospective clinical study.

Objective: Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years.

Methods: A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery.

Results: Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery (P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up.

Conclusions: Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.

Keywords: adverse events; autologous local bone graft; early fusion; good clinical outcome; low cost; platelet-rich plasma; posterolateral lumbar fusion.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Postoperative course of posterolateral fusion between L4-5 on CT coronal images: (A) Two weeks after surgery; (B) Three months after surgery; (C) Six months after surgery. The right side with a bone graft with PRP achieved bony fusion. (D) Twelve months after surgery. Bilateral posterolateral fusion was complete. All panels show an AP view; therefore, the left side of each panel shows the right side of the patient.
Figure 2.
Figure 2.
Time course of the PRP/control side ratio for the fused bone area. Fused bone areas on the PRP and control sides were almost the same at 2 weeks after surgery. At 3 and 6 months after surgery, this area was significantly wider on the PRP side than on the control side with autologous bone graft only (*P < .05). At 12 months after surgery, the area on the PRP side was still wider, but with no significant difference between the sides.
Figure 3.
Figure 3.
Time course of the PRP/control side ratio for bone absorption. The rates of bone absorption on the PRP and control sides were almost the same at 2 weeks after surgery. At 3 and 6 months after surgery, there was significantly less bone absorption on the PRP side than on the control side with autologous bone graft only (*P < .01, **P < .005). At 12 months after surgery, bilateral bone absorption did not differ significantly.

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Source: PubMed

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