Positive effect on spinal fusion by the combination of platelet-rich plasma and collagen-mineral scaffold using lumbar posterolateral fusion model in rats

Jen-Chung Liao

doi:10.1186/s13018-019-1076-2

Abstract

BackgroundPlatelet-rich plasma (PRP) is autologous in origin and contains a high concentration of platelets which is a source of various growth factors. Previous studies have suggested that PRP has a positive effect in accelerating fusion by an autologous bone graft in a lumbar fusion. The role of PRP on artificial bone grafts in spinal fusion remains controversial. In this study, positive effect on spinal fusion by PRP was hypothesized; in vitro and in vivo studies were designed to test this hypothesis.MethodsPRP was produced from peripheral blood of Sprague-Dawley (SD) rats. A lumbar posterolateral arthrodesis model was used to test the efficacy of PRP on spinal fusion. Thirty SD rats were divided into three groups by different implants: the PRP group, PRP plus collagen-mineral carrier; the platelet-poor plasma (PPP) group, PPP plus collagen-mineral carrier; and the control group, collagen-mineral only. Spinal fusion was examined using plain radiographs, micro-computed tomography (micro-CT), manual palpation, and histological analysis. The fusion rate by micro-CT and that by manual palpation in groups were compared.ResultsIn the micro-CT results, 16 fused segments were observed in the PRP group (80%, 16/20), 2 in the PPP group (10%, 2/20), and 2 in the control group (10%, 2/20). The fusion rate, determined by manual palpation, was 60% (6/10) in the PRP group, 0% (0/10) in the PPP group, and 0% (0/10) in the control group. Histology showed that the PRP group had more new bone and matured marrow formation.ConclusionsThe results of this study demonstrated that PRP on an artificial bone carrier had positive effects on lumbar spinal fusion in rats. In the future, this composite could be potentially used as a bone graft in humans.

Highlights

Platelet-rich plasma (PRP) is autologous in origin and contains a high concentration of platelets which is a source of various growth factors
PRP, and platelet-poor plasma Platelet concentrations in the blood and PRP were measured for each rat
Weibrich et al demonstrated that the platelet concentration in PRP required for a positive effect on bone regeneration in vivo happens within a limited range; it was between two times and six times higher than the concentration of whole blood [20]

Summary

Introduction

Platelet-rich plasma (PRP) is autologous in origin and contains a high concentration of platelets which is a source of various growth factors. Achieving a successful spinal fusion remains a fundamental procedure for an unstable spine For this purpose, an autogenous bone graft is still the gold standard of bone graft, but autogenous bone grafts are limited by the amount of bone available and significant donor site morbidity [1, 2]. Bone morphogenetic proteins (BMPs), such as BMP-2 and BMP-7, exhibit bone induction potency and are available commercially and approved by the US Food and Drug Administration (FDA) for clinical use in spinal procedures [8] Local adverse effects such as a hyper-inflammation reaction and unwanted ectopic bone formation have been reported to be associated with doses currently used [9]. Preparation of stem cells is not easy and the clinical application is limited

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