title: Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To determine the effect on fusion of adding platelet gel to autologous iliac crest graft.
  
  
  BACKGROUND
  Platelet gel is an osteoinductive material prepared by ultra-concentration of platelets and contains multiple growth factors. Proprietary commercial methods are available for harvesting autologous platelet gel concentrates for use as graft supplement in spine fusions.
  
  
  METHODS
  We reviewed 76 consecutive patients who underwent instrumented posterolateral lumbar fusion with autologous iliac crest bone graft mixed with autologous growth factor (AGF). A control group was randomly selected from patients who underwent instrumented posterolateral lumbar fusion with autologous bone graft alone. The groups were matched for age, sex, smoking history, and number of levels fused. Demographic, surgical, and clinical data were collected from medical records. Diagnosis of nonunion was based on exploration during revision surgery or evidence of nonunion on computerized tomography. The Fisher exact test was used to compare fusion rates.
  
  
  RESULTS
  In both groups, mean age was 50 years, and 24% were smokers. The nonunion rate was 25% in the AGF group and 17% in the control group. This difference was not statistically significant (P = 0.18).
  
  
  CONCLUSIONS
  Platelet gel preparation requires blood draws from the patient. This procedure adds to the risk and cost of surgery. The technique for AGF harvest evaluated in this study provides the highest concentration of platelets among the commercially available methods. Despite this, we showed that platelet gel failed to enhance fusion rate when added to autograft in patients undergoing instrumented posterolateral spinal fusion. The authors do not recommend the use of platelet gel to supplement autologous bone graft during instrumented posterolateral spinal fusion.
authors.affiliation: Leatherman Spine Center, Louisville, Kentucky 40202, USA. lcarreon@spinemds.com
authors.forename: Leah Yacat
authors.initials: LY
authors.lastname: Carreon
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.forename: Yoram
authors.initials: Y
authors.lastname: Anekstein
authors.forename: Rolando M
authors.initials: RM
authors.lastname: Puno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005782:Gels / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration / Q000187:drug effects; D010982:Platelet-Derived Growth Factor / Q000494:pharmacology / Q000627:therapeutic use*; D011542:Pseudarthrosis / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D005782:Gels; D010982:Platelet-Derived Growth Factor