Effect of platelet-rich plasma gel combined with decompression bone grafting on lumbar fusion surgery_West China Medical Journal

Authors：

XIE Bin , XU Hongda , DENG Haitao , LI Mingfan , HU Youpeng , ZHANG Lei , WANG Tieheng , ZHAO Shengxin , GOU Yuankun ,  QING Peidong

Department of Spine, Mianyang Orthopedic Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

QING Peidong, Email: 415050120@qq.com

Keywords：

Platelet-rich plasma gel; decompression bone; lumbar fusion

DOI：

10.7507/1002-0179.202508169

Video：

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Objective To observe the effect of platelet-rich plasma (PRP) gel combined with local decompression bone grafting on lumbar fusion. Methods A total of 80 patients with lumbar degenerative diseases who needed posterior lumbar fusion surgery at Mianyang Orthopedic Hospital between January and June 2024 were selected and randomly divided into groups A and B using the random number method. For patients in group A (n=40), decompression bone graft combined with PRP gel was implanted intraoperatively, while those in group B (n=40) received only decompression bone graft. The Visual Analogue Scale (VAS) pain scores before surgery and 3 days, 1 month and 3 months after surgery, the Oswestry Disability Index (ODI) and the Activities of Daily Living (ADL) scores before surgery and 1 month and 3 months after surgery, the intervertebral space height before surgery and 1 month and 3, 6, and 12 months after surgery, and the intervertebral fusion rate 3, 6, and 12 months after surgery were observed between the two groups. Results The VAS, ODI and ADL scores of group A were significantly better than those of group B 3 months after surgery (P<0.05). Regarding the intervertebral space height, the interaction effect of time and group was statistically significant 6 and 12 months after surgery (P<0.05), and the intervertebral space height of group A was better than that of group B at these time points (P<0.05). The difference in fusion time survival curves between the two groups was statistically significant (P=0.008), group A was better than group B. Conclusion Intervertebral bone grafting with PRP gel mixed with local decompression bone can significantly increase the intervertebral fusion rate, reduce the degree of intervertebral space subsidence, and significantly improve the postoperative pain and quality of life of patients, providing an effective and feasible new strategy for improving the intervertebral fusion rate after lumbar fusion surgery.

Citation： XIE Bin, XU Hongda, DENG Haitao, LI Mingfan, HU Youpeng, ZHANG Lei, WANG Tieheng, ZHAO Shengxin, GOU Yuankun, QING Peidong. Effect of platelet-rich plasma gel combined with decompression bone grafting on lumbar fusion surgery. West China Medical Journal, 2026, 41(4): 611-617. doi: 10.7507/1002-0179.202508169 Copy

1.	Salenius P, Laurent LE. Results of operative treatment of lumbar disc herniation. A survey of 886 patients. Acta Orthop Scand, 1977, 48(6): 630-634.
2.	Yan S, Taotao T, Shunwei Y, et al. Cervical spondylopathy and lumbar intervertebral disc herniation coexist in free radical metabolism and focus separation in the body. J Healthc Eng, 2021, 2021: 1480282.
3.	Zhang X, Zhao Z, Niu C, et al. Spinal biomechanical modelling in the process of lumbar intervertebral disc herniation in middle-aged and elderly. J Healthc Eng, 2021, 2021: 2869488.
4.	Postacchini F, Postacchini R. Operative management of lumbar disc herniation: the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl, 2011, 108: 17-21.
5.	方喬洲, 張全兵, 鐘華璋, 等. 腰椎間盤突出癥的治療研究進展. 安徽醫學, 2023, 44(2): 229-233.
6.	黃希, 王文波. 長骨骨缺損的組織工程治療現狀. 臨床與病理雜志, 2021, 41(2): 456-461.
7.	Vulcano E, Murena L, Cherubino P, et al. Treatment of severe post-traumatic bone defects with autologous stem cells loaded on allogeneic scaffolds. Surg Technol Int, 2012, 22: 291-301.
8.	Yasuda H, Yano K, Wakitani S, et al. Repair of critical long bone defects using frozen bone allografts coated with an rhBMP-2-retaining paste. J Orthop Sci, 2012, 17(3): 299-307.
9.	Wang M, Gao W. Fixation of platelet-rich plasma and fibrin gels on knee cartilage defects after microfracture with arthroscopy. Int Orthop, 2022, 46(8): 1761-1766.
10.	He C, Liu K, Zhao Z, et al. Platelet-rich plasma combined with lyophilizing thrombin powder for the treatment of complicated enterocutaneous fistula: a case report. Front Surg, 2023, 10: 1252045.
11.	方夢澤. 基于“腎虛骨痿”理論對老年腰椎術后椎間融合質量評價及仙靈骨葆膠囊的臨床效果觀察. 濟南: 山東中醫藥大學, 2022.
12.	Dai Y, Li D, Wen X. Percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: an efficacy analysis. Am J Transl Res, 2024, 16(3): 829-837.
13.	Pojskic M, Bisson E, Oertel J, et al. Lumbar disc herniation: epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations. World Neurosurg X, 2024, 22: 100279.
14.	中國康復醫學會脊柱脊髓專業委員會基礎研究與轉化學組. 腰椎間盤突出癥診治與康復管理指南. 中華外科雜志, 2022, 60(5): 401-408.
15.	Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine (Phila Pa 1976), 2006, 31(20): 2329-2336.
16.	Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res, 2000(371): 10-27.
17.	Holliger EH, Trawick RH, Boden SD, et al. Morphology of the lumbar intertransverse process fusion mass in the rabbit model: a comparison between two bone graft materials--rhBMP-2 and autograft. J Spinal Disord, 1996, 9(2): 125-128.
18.	Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma, 1989, 3(3): 192-195.
19.	Ito Z, Imagama S, Kanemura T, et al. Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study. Eur Spine J, 2013, 22(5): 1158-1163.
20.	Ohtori S, Suzuki M, Koshi T, et al. Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: a prospective, randomized study with a 2-year follow-up. Eur Spine J, 2011, 20(4): 635-639.
21.	Agazzi S, Reverdin A, May D. Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg, 1999, 91(2 Suppl): 186-192.
22.	Ito Z, Matsuyama Y, Sakai Y, et al. Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion. Spine (Phila Pa 1976), 2010, 35(21): E1101-1105.
23.	Makino T, Kaito T, Fujiwara H, et al. Does fusion status after posterior lumbar interbody fusion affect patient-based QOL outcomes? An evaluation performed using a patient-based outcome measure. J Orthop Sci, 2014, 19(5): 707-712.
24.	Suh KT, Park WW, Kim SJ, et al. Posterior lumbar interbody fusion for adult isthmic spondylolisthesis: a comparison of fusion with one or two cages. J Bone Joint Surg Br, 2008, 90(10): 1352-1356.
25.	Kim HJ, Yang JH, Chang DG, et al. Adult spinal deformity: current concepts and decision-making strategies for management. Asian Spine J, 2020, 14(6): 886-897.
26.	Ko S, Jun C, Nam J. Comparison of fusion rate and functional outcome between local cancellous bone plus demineralized bone matrix and local bone in 1-level posterior lumbar interbody fusion. Clin Spine Surg, 2022, 35(7): E621-E626.
27.	謝彬, 劉穎, 胥鴻達, 等. 富血小板血漿在腰痛應用中的研究現狀. 實用骨科雜志, 2024, 30(11): 1003-1007.
28.	Solakoglu ?, Heydecke G, Amiri N, et al. The use of plasma rich in growth factors (PRGF) in guided tissue regeneration and guided bone regeneration. A review of histological, immunohistochemical, histomorphometrical, radiological and clinical results in humans. Ann Anat, 2020, 231: 151528.
29.	Mariani E, Pulsatelli L, Cattini L, et al. Pure platelet and leukocyte-platelet-rich plasma for regenerative medicine in orthopedics-time- and preparation-dependent release of growth factors and effects on synovial fibroblasts: a comparative analysis. Int J Mol Sci, 2023, 24(2): 1512.
30.	Farshidfar N, Amiri MA, Estrin NE, et al. Platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF): a systematic review across all fields of medicine. Periodontol 2000, 2025.
31.	Wang C, Xu F, Jia L, et al. Lumbar fusion efficacy with local bone grafting and platelet-rich plasma: a clinical investigation in treating degenerative lumbar spinal stenosis in the elderly. Int Orthop, 2024, 48(11): 2963-2970.
32.	Sato K, Funayama T, Noguchi H, et al. Effect of platelet-rich plasma on the acceleration of graft bone catabolism in lateral lumbar interbody fusion in a short-term assessment. J Artif Organs, 2024, 27(3): 247-252.
33.	Kubota G, Kamoda H, Orita S, et al. Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: a prospective randomized controlled trial. Spine J, 2019, 19(2): e34-e40.
34.	Liu Y, Li NH. Factors associated with intervertebral cage subsidence in posterior lumbar fusion. J Orthop Surg Res, 2024, 19(1): 7.

1. Salenius P, Laurent LE. Results of operative treatment of lumbar disc herniation. A survey of 886 patients. Acta Orthop Scand, 1977, 48(6): 630-634.
2. Yan S, Taotao T, Shunwei Y, et al. Cervical spondylopathy and lumbar intervertebral disc herniation coexist in free radical metabolism and focus separation in the body. J Healthc Eng, 2021, 2021: 1480282.
3. Zhang X, Zhao Z, Niu C, et al. Spinal biomechanical modelling in the process of lumbar intervertebral disc herniation in middle-aged and elderly. J Healthc Eng, 2021, 2021: 2869488.
4. Postacchini F, Postacchini R. Operative management of lumbar disc herniation: the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl, 2011, 108: 17-21.
5. 方喬洲, 張全兵, 鐘華璋, 等. 腰椎間盤突出癥的治療研究進展. 安徽醫學, 2023, 44(2): 229-233.
6. 黃希, 王文波. 長骨骨缺損的組織工程治療現狀. 臨床與病理雜志, 2021, 41(2): 456-461.
7. Vulcano E, Murena L, Cherubino P, et al. Treatment of severe post-traumatic bone defects with autologous stem cells loaded on allogeneic scaffolds. Surg Technol Int, 2012, 22: 291-301.
8. Yasuda H, Yano K, Wakitani S, et al. Repair of critical long bone defects using frozen bone allografts coated with an rhBMP-2-retaining paste. J Orthop Sci, 2012, 17(3): 299-307.
9. Wang M, Gao W. Fixation of platelet-rich plasma and fibrin gels on knee cartilage defects after microfracture with arthroscopy. Int Orthop, 2022, 46(8): 1761-1766.
10. He C, Liu K, Zhao Z, et al. Platelet-rich plasma combined with lyophilizing thrombin powder for the treatment of complicated enterocutaneous fistula: a case report. Front Surg, 2023, 10: 1252045.
11. 方夢澤. 基于“腎虛骨痿”理論對老年腰椎術后椎間融合質量評價及仙靈骨葆膠囊的臨床效果觀察. 濟南: 山東中醫藥大學, 2022.
12. Dai Y, Li D, Wen X. Percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: an efficacy analysis. Am J Transl Res, 2024, 16(3): 829-837.
13. Pojskic M, Bisson E, Oertel J, et al. Lumbar disc herniation: epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations. World Neurosurg X, 2024, 22: 100279.
14. 中國康復醫學會脊柱脊髓專業委員會基礎研究與轉化學組. 腰椎間盤突出癥診治與康復管理指南. 中華外科雜志, 2022, 60(5): 401-408.
15. Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine (Phila Pa 1976), 2006, 31(20): 2329-2336.
16. Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res, 2000(371): 10-27.
17. Holliger EH, Trawick RH, Boden SD, et al. Morphology of the lumbar intertransverse process fusion mass in the rabbit model: a comparison between two bone graft materials--rhBMP-2 and autograft. J Spinal Disord, 1996, 9(2): 125-128.
18. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma, 1989, 3(3): 192-195.
19. Ito Z, Imagama S, Kanemura T, et al. Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study. Eur Spine J, 2013, 22(5): 1158-1163.
20. Ohtori S, Suzuki M, Koshi T, et al. Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: a prospective, randomized study with a 2-year follow-up. Eur Spine J, 2011, 20(4): 635-639.
21. Agazzi S, Reverdin A, May D. Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg, 1999, 91(2 Suppl): 186-192.
22. Ito Z, Matsuyama Y, Sakai Y, et al. Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion. Spine (Phila Pa 1976), 2010, 35(21): E1101-1105.
23. Makino T, Kaito T, Fujiwara H, et al. Does fusion status after posterior lumbar interbody fusion affect patient-based QOL outcomes? An evaluation performed using a patient-based outcome measure. J Orthop Sci, 2014, 19(5): 707-712.
24. Suh KT, Park WW, Kim SJ, et al. Posterior lumbar interbody fusion for adult isthmic spondylolisthesis: a comparison of fusion with one or two cages. J Bone Joint Surg Br, 2008, 90(10): 1352-1356.
25. Kim HJ, Yang JH, Chang DG, et al. Adult spinal deformity: current concepts and decision-making strategies for management. Asian Spine J, 2020, 14(6): 886-897.
26. Ko S, Jun C, Nam J. Comparison of fusion rate and functional outcome between local cancellous bone plus demineralized bone matrix and local bone in 1-level posterior lumbar interbody fusion. Clin Spine Surg, 2022, 35(7): E621-E626.
27. 謝彬, 劉穎, 胥鴻達, 等. 富血小板血漿在腰痛應用中的研究現狀. 實用骨科雜志, 2024, 30(11): 1003-1007.
28. Solakoglu ?, Heydecke G, Amiri N, et al. The use of plasma rich in growth factors (PRGF) in guided tissue regeneration and guided bone regeneration. A review of histological, immunohistochemical, histomorphometrical, radiological and clinical results in humans. Ann Anat, 2020, 231: 151528.
29. Mariani E, Pulsatelli L, Cattini L, et al. Pure platelet and leukocyte-platelet-rich plasma for regenerative medicine in orthopedics-time- and preparation-dependent release of growth factors and effects on synovial fibroblasts: a comparative analysis. Int J Mol Sci, 2023, 24(2): 1512.
30. Farshidfar N, Amiri MA, Estrin NE, et al. Platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF): a systematic review across all fields of medicine. Periodontol 2000, 2025.
31. Wang C, Xu F, Jia L, et al. Lumbar fusion efficacy with local bone grafting and platelet-rich plasma: a clinical investigation in treating degenerative lumbar spinal stenosis in the elderly. Int Orthop, 2024, 48(11): 2963-2970.
32. Sato K, Funayama T, Noguchi H, et al. Effect of platelet-rich plasma on the acceleration of graft bone catabolism in lateral lumbar interbody fusion in a short-term assessment. J Artif Organs, 2024, 27(3): 247-252.
33. Kubota G, Kamoda H, Orita S, et al. Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: a prospective randomized controlled trial. Spine J, 2019, 19(2): e34-e40.
34. Liu Y, Li NH. Factors associated with intervertebral cage subsidence in posterior lumbar fusion. J Orthop Surg Res, 2024, 19(1): 7.

West China Medical Journal

Effect of platelet-rich plasma gel combined with decompression bone grafting on lumbar fusion surgery

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