Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Orthopedic Surgery, Ichihara Hospital, Tsukuba, Ibaraki, Japan.
J Orthop Surg Res. 2024 Oct 26;19(1):691. doi: 10.1186/s13018-024-05184-y.
Lateral lumbar interbody fusion (LLIF) via a retroperitoneum approach has gained popularity due to minimal invasiveness, which avoids resection of the spinous process and laminae. However, as challenges in grafting autogenous bone persist, artificial bone has been tested in Japan to fill the spinal cage. Platelet-rich plasma (PRP) contains growth factors and anti-inflammatory cytokines to promote cellular proliferation and repair damaged tissues. While the effects of PRP on tendon and ligament repair are widely known, any effects on bone healing are scarcely reported. However, PRP-loaded artificial bone carries potential to improve intervertebral bone fusion.
This study assessed whether PRP enhances intervertebral bone fusion in LLIF surgery using β-tricalcium phosphate artificial bone.
The current study was a prospective, randomized, controlled trial. We evaluated 13 consecutive patients undergoing LLIF surgery in our hospital. Patients received artificial bone impregnated with PRP or without PRP within the same fusion cage. The primary outcome was the intervertebral bone fusion rate at 6 and 12 months postoperatively, evaluated using CT imaging. The intervertebral bone fusion rates with and without PRP loading and with and without contact part between the endplate and the artificial bone were compared. Secondary outcomes included clinical evaluations using visual analog scale scores for low back pain, buttock-leg pain, and leg numbness from the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI), plus adverse events information.
Of the 13 patients (29 vertebral segments) included, bone fusion was observed in 43.4% of the PRP group and 26.1% of the non-PRP group at 6 months (p = 0.216). At 12 months, fusion rates were 60.9% with PRP and 34.8% without PRP (p = 0.074). The fusion rate was significantly higher in cases with good contact between the vertebral endplate and the artificial bone (p = 0.0004). Clinical scores improved postoperatively. Adverse events were in accordance with expectations from LLIF surgery and no PRP-specific events occurred.
PRP did not significantly improve intervertebral bone fusion rates in LLIF surgeries, particularly in cases with poor contact between the vertebral endplate and artificial bone. While PRP may have a limited role in enhancing bone fusion, maintaining good contact between the vertebral endplate and artificial bone is crucial for successful outcomes. Further research is needed to explore optimal uses of PRP in spinal fusion surgeries.
经腹膜后入路的侧方腰椎椎间融合术（LLIF）因其微创性而受到青睐，微创性避免了棘突和椎板的切除。然而，由于自体骨移植存在挑战，日本已经在尝试使用人工骨填充椎间融合器。富含血小板的血浆（PRP）含有生长因子和抗炎细胞因子，可促进细胞增殖和修复受损组织。虽然 PRP 对肌腱和韧带修复的效果已被广泛研究，但对于骨愈合的效果却鲜有报道。然而，负载 PRP 的人工骨有可能改善脊柱骨融合。
本研究旨在评估 PRP 对使用β-磷酸三钙人工骨行 LLIF 手术的椎间骨融合的影响。
本研究为前瞻性、随机、对照临床试验。我们评估了我院 13 例连续接受 LLIF 手术的患者。患者在同一融合笼内接受负载 PRP 的人工骨或未负载 PRP 的人工骨治疗。主要结局为术后 6 个月和 12 个月时使用 CT 成像评估的椎间骨融合率。比较了负载 PRP 和未负载 PRP 以及人工骨终板与人工骨接触部分有无的椎间骨融合率。次要结局包括使用日本骨科协会腰痛评估问卷（JOA-BPEQ）和 Oswestry 残疾指数（ODI）的视觉模拟量表评分进行临床评估，以及低腰痛、臀腿痛和下肢麻木的评估，同时还记录了不良事件信息。
13 例患者（29 个节段）中，PRP 组 6 个月时骨融合率为 43.4%，非 PRP 组为 26.1%（p=0.216）。12 个月时，PRP 组融合率为 60.9%，非 PRP 组为 34.8%（p=0.074）。椎体终板与人工骨接触良好的患者融合率显著更高（p=0.0004）。术后临床评分均改善。不良事件与 LLIF 手术的预期相符，未发生与 PRP 相关的特定事件。
PRP 并未显著提高 LLIF 手术中的椎间骨融合率，尤其是在椎体终板与人工骨接触不良的情况下。虽然 PRP 在增强骨融合方面可能作用有限，但维持椎体终板与人工骨之间的良好接触对于获得良好的手术效果至关重要。需要进一步研究探索 PRP 在脊柱融合手术中的最佳应用。
