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

introductionWe 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

methodsThis 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.

resultsIn 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).

conclusionsPRP 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.