Sostituti degli innesti ossei in chirurgia vertebrale: gel piastrinico

Platelet gel (PG), an autologous platelet concentrate, is rich in autologous growth factors that can promote chemotaxis, proliferation, and activation of mesenchymal cells, osteoblasts, fibroblasts and theoretically improve bone graft incorporation. The aim of this study was to investigate the utility of pg to enhance posterior and postero-lateral spine fusion. Twenty instrumented posterior and lumbar or lumbosacral posterolateral fusions were treated with autologous cancellous bone grafts supplemented with autologous PG. The mean age of patients was 32.4 yrs. (13-66). Mean fused levels were 5.9. The 1-year radiographic fusion rate in these patients was compared with 10 age- and sex-matched controls who had undergone spinal fusion without PG supplementation (4 scoliosis, 4 instability, 1 spondylolisthesis, 1 kyphosis). Radiographic signs of fusion were detected in 80% of PG treated patients at the 3-month F.U. control. There was an overall radiographic evidence of fusion in 90% of these patients at the 6-month F.U. In posterolateral fusions and scoliosis surgery the six-month fusion rate was 80 % and 100 %, respectively. Increase in the volume and density of the fusion mass was appreciated between the 3- and 6-month follow-up. Lack of radiographic fusion at 6 months was observed in 2 asymptomatic subjects who underwent PL fusion (1 L4-L5, 1 L4-S1). One of them was a 66-year-old heavy smoker male, with HCV infection. No differences in the fusion rate of subjects operated on with or without PG was detected one year after surgery. The PG used in the current study is cheap, safe (autologous), and easy to prepare. We observed early (3-6 months postoperative) bony deposition in the site of fusion but no difference in the 1-year fusion rate was noted in patients supplemented or not with PG.