My surgeon wants to use Platelet Rich Plasma and Stem Cell Therapy during surgery

In this article, Ross Hauser, MD explores research on the use of Platelet Rich Plasma and Stem Cell Therapy during and after surgery and examines suggestions that use of these treatments before surgery could help patients avoid surgery.

Exciting new research acknowledges that doctors are doing everything they can to make the surgical experience a successful one. In fact there has been “a never-ending quest” to improve surgical outcome with the use of better tools, better techniques, and better MRIs.

In fact the emergence of new MRI accuracy techniques along with the development of innovative minimally invasive arthroscopic technical skills makes for new improvements to classic procedures and implants to improve short-term patient complaints and initial, mid-term, and long-term patient outcomes.

Above is the happy news about the progress of surgery and if I ever need a surgery I will be glad for these advancements. However, the real advancements according to researchers are Platelet Rich Plasma Therapy and Stem Cell Therapy to enhance surgical success and Platelet Rich Plasma Therapy and Stem Cell Therapy as a primary treatment to avoid surgery.

A new era is surgical technique is the era of biomaterials

This is from independent research: The use of regenerative and/or biological adjuncts to aid the healing process has followed in the drive for continual improvement, and major breakthroughs in basic science have significantly unraveled the mechanisms of key healing and regenerative pathways. A wide spectrum of primary and complementary regenerative treatments is becoming increasingly available, including blood-derived preparations PRP Therapy, hormones and growth factors, bone marrow preparations and stem cells.

This is a new era in the application of biologically active material, and it is transforming clinical practice by providing effective supportive treatments either at the time of the procedure or during the postoperative period. Regenerative treatments are currently in active use to enhance many areas of orthopedic surgery in an attempt to improve success and outcome.”1

The message is clear. Stem Cell Therapy, Platelet Rich Plasma Therapy and Growth Factors after and during surgery speed healing.

But why have the surgery if these therapies can be employed BEFORE the surgery?


The success of Platelet Rich Plasma Therapy in treating patients after surgery depends on the extent of damage done by the surgery


In new research this notion is being dispelled. Doctors have found that PRP after a rotator cuff surgery “significantly improved biomechanical properties at the rotator cuff tendon-bone interface.”2,3

Any Prolotherapist using PRP knows its high success rate in non-surgical settings, but let’s look at PRP used during spinal fusion surgery. In one particular study published in the European Spine Journal, researchers used PRP during a fusion surgery to see if it would help. They acknowledged the contradictory and limited research in PRP applications during spinal fusions. They set out to clarify the research by conducting a randomized controlled study in which they assessed the effect of PRP when pasted (grafted) onto the iliac crest bone during a posterior lumbar interbody fusion. Their results showed:

In this study, adding PRP in posterior lumbar interbody fusion did not lead to a substantial improvement or deterioration when compared with autologous bone only. No inhibitory effect of PRP was observed on CT-scans. From a clinical and radiological point of view, the use of PRP seems to be justified in posterior lumbar interbody fusion surgery. From an economical point of view, the expense of using PRP cannot be justified until statistical significance can be reached in a larger study.”4

So they agreed it could help, but it does not help enough. Why are we pointing this study out?

Because spinal fusions in general have poor results. Given the high “reopen” rate of spinal fusion or second surgery being near 12% and the “significant advances” in spinal surgery technology that is not as good as the older technology (that wasn’t too good either), the spinal fusion itself should be in question.5-6

So it is unclear whether pasting PRP onto bone during fusion could help. What they should have researched, however, is if the PRP injections could have helped the soft tissue damage before the surgery that necessitated a bone graph. Prolotherapy in general is an excellent alternative to surgery, even spinal fusion. But can PRP help after a failed fusion surgery?

PRP accelerates healing after surgery research

A detailed consultation and examination is needed to assess realistic goals for the patient’s care.

 

References for this article

1.Murrell WD, Anz AW, Badsha H, Bennett WF, Boykin RE, Caplan AI. Regenerative treatments to enhance orthopedic surgical outcome.PM R. 2015 Apr;7(4 Suppl):S41-52. doi: 10.1016/j.pmrj.2015.01.015.

2 Ersen A, Demirhan M, Atalar AC, apicioğlu M, Baysal G. Platelet-rich plasma for enhancing surgical rotator cuff repair: evaluation and comparison of two application methods in a rat model. Arch Orthop Trauma Surg. 2013 Dec 31. [Epub ahead of print]

3. Yang J, Sun Y, Xu P, Cheng B. Can patients get better clinical outcomes by using PRP in rotator cuff repair: a meta-analysis of randomized controlled trials. J Sports Med Phys Fitness. 2015 Oct 16. [Epub ahead of print]

4. Sys J, Weyler J, Van Der Zijden T, Parizel P, Michielsen J. Platelet-rich plasma in mono-segmental posterior lumbar interbody fusion. Eur Spine J. 2011 Oct;20(10):1650-7. Epub 2011 Jul 10.

5. Kim CH, Chung CK, Park CS, Choi B, Kim MJ, Park BJ. Reoperation rate after surgery for lumbar herniated intervertebral disc disease: Nation-wide cohort study. Spine (Phila Pa 1976). 2012 Sep 27.

6. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine (Phila Pa 1976). 2007 Sep 1;32(19):2119-26.

7. Rafols C, Monckeberg JE, Numair J, Botello J, Rosales J. Platelet-Rich Plasma Augmentation of Arthroscopic Hip Surgery for Femoroacetabular Impingement: A Prospective Study With 24-Month Follow-up. Arthroscopy. 2015 Oct;31(10):1886-92. doi: 10.1016/j.arthro.2015.03.025. Epub 2015 May 15.

8. Marmotti A, Rossi R, Castoldi F, Roveda E, Michielon G, Peretti GM. PRP and articular cartilage: a clinical update. Biomed Res Int. 2015;2015:542502. doi: 10.1155/2015/542502. Epub 2015 May 5.

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