425 - Platelet Rich Fibrin Matrix and Bone Marrow Aspirate Preparation Enhan...

#425 Platelet Rich Fibrin Matrix and Bone Marrow Aspirate Preparation Enhances Posterolateral Lumbar Spine Arthrodesis

Biologic Therapies

Poster Presented by: A. Brecevich

Author(s):

A. Brecevich (1)
P. Kiely (1)
R. Brenner (1)
C. Abjornson (1)
F. Cammisa (1)

(1) Hospital for Special Surgery, Spine Research, New York, NY, USA

Abstract

Introduction: Numerous studies have demonstrated that platelet rich preparations applied to surgical sites, injuries and wounds are a safe and effective method to improve wound and soft tissue healing. McCarrell and Fortier reported positive effects on gene expression (increased collagen 1 and decreased MMP-13) in flexor tendon explants cultured in platelet rich plasma (PRP) [1]. Peerbooms et al found that platelet rich plasma injection versus corticosteroid injection improved lateral epicondylitis in a double blind randomized controlled trial [2]. No studies yet have investigated the significance of PRP preparations on spine fusion.

Objective: We hypothesized that platelet rich fibrin matrix (PRFM) in combination with a bone marrow aspirate preparation would accelerate spine fusion in patients undergoing posterolateral lumbar spine arthrodesis with local autograft.

Materials and Methods: We retrospectively reviewed all patients undergoing a standard posterolateral lumbar fusion (PLF) using local autograft, in combination with platelet rich fibrin matrix (PRFM) and the bone marrow aspirate preparation, by a single surgeon in a single institution. The PRFM is a variation of PRP and is obtained using a novel centrifugation technique, whereby the fibrin matrix is formed by the activation of the fibrin clotting cascade by the addition of the calcium chloride and a second centrifugation step (Vertical Spine Autologous Platelet System, Musculoskeletal Transplant Foundation, Edison, New Jersey). This flexible PRFM membrane was then combined with the bone marrow aspirate preparation, which consisted of a porous calcium phosphate bone graft substitute soaked in an autologous bone marrow aspiration. This biological amalgamation was then added to the autograft in the posterolateral fusion bed. Postoperatively, each patient was assessed in the outpatients, by clinical examination and by the completion of the Oswestry Disability Index (ODI). Radiologically, each patient was evaluated by an independent attending radiologist using plain radiographs and computed tomography (CT).

Results: Over a nine month period, a total of 19 patients underwent standard PLF using local bone, PRFM and the bone marrow aspirate preparation. The male to female ratio was 10 male:9 female. The mean age was 62.8 years (range: 38-85 years). The mean BMI was 29.7 (range: 17-44). Seventeen patients (90%) underwent PLF for lumbar spinal stenosis, and the remaining two patients had degenerative disc disease and spondylolisthesis respectively. Eleven patients (58%) underwent a two level PLF. Six patients (32%) underwent a single level fusion, with the remaining two patients (10%) undergoing a three level fusion. Postoperatively, there were no cases of dural lacerations, neurological deficits or infections. On clinical follow up at one year, twelve of the nineteen patients had a statistically significant decrease of 89% in their mean Oswestry Disability Index (ODI) score. Plain radiograph and CT confirmed satisfactory fusion in all (n=19) patients at ten months (range: 7-13 months).

Conclusion: Our results suggest that platelet rich fibrin matrix technology enhances spinal fusion and has the potential for avoiding the morbidity associated with the harvesting of autologous iliac crest bone graft.