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Influence of platelet-rich plasma on the anterior fusion in spinal injuries: a qualitative and quantitative analysis
Erik K Hartmann1, Timo Heintel, Robert H Morrison
1Department of Trauma and Reconstructive Surgery, University Hospital Wuerzburg, Germany. erik-h@gmx.de
Introduction:
The effects of platelet-rich plasma (PRP) were monitored by performing a controlled cohort study of patients undergoing an anterior spinal fusion. One group was treated with the addition of PRP. The growth factors contained within the blood platelets are known to play an important role in the new formation of bone following fractures or the implantation of bone grafts. But the results following the use of PRP in spinal fusion are not yet published.
Method:
The study involved a group of 15 patients, who had suffered an injury of the thoracic or lumbar spine and had undergone an anterior fusion using cages. They had received an additional posterior stabilisation and/or anterior implants as well as bone graft combined with PRP. A control group made up of 20 patients received a similar treatment, but without the addition of PRP. A CT scan was performed of all patients during follow-up examinations. The area on the left side of the cage, where the bone graft with or without PRP had been applied, was analysed and the patients were divided into three classes, depending upon the rate of fusion: complete fusion, incomplete fusion and no/minimal ossification. In cases which were classified as complete or incomplete ossification, an additional CT volumetry and densitometry was performed. The patient-referred outcome was documented using the VAS spinal score.
Results:
In both groups, 40% of the patients had reached a complete fusion in the CT scans. No or minimal fusion was documented in 20% of the PRP group and 30% of the control group. When measuring the density within the newly formed bone mass, both groups showed nearly identical percentages with a density of over 100 Hounsfield units (HU). The share of bone with a density of over +500 HU was 29.33% in the PRP group and 23.57% in the control group. Within the partition of over +100 HU, the absolute density was significantly higher in the PRP group (639.7 vs. 514.2 HU). Similar results could be shown within the partition of over +500 HU (930.7 vs. 846 HU). The VAS scores showed no significant differences between the two groups.
Conclusion:
The additional application of autologous PRP involves very little risk for the patients. The study implies that the use of PRP provides a faster fusion and higher density values within the fusion mass. A clear advancement in spinal fusion in terms of a clinical benefit remains questionable.