Platelet Rich Plasma in Orthopedic Surgical Medicine.

There is a global interest in optimizing post-surgical tissue repair strategies, leading to better patient outcomes and fewer complications, most ideally with reduced overall cost. In this regard, in recent years, the interest in autologous biological treatments in orthopedic surgery and sports medicine has increased greatly, and the addition of platelet-rich plasma (PRP) to the surgical armamentarium is of particular note. Unfortunately, the number of PRP preparation devices has also grown immensely over the recent decades, raising meaningful concern for the considerable variation in the qualities of currently available PRP preparations. The lack of consensus on the standardization of PRP preparation and of agreement on condition specific PRP formulations is largely responsible for the sometimes contradictory outcomes in the literature. Furthermore, the full potential of PRP technology, the concept of individualized treatment protocols based on bioformulation options, and platelet dosing, angiogenesis, and antimicrobial and painkilling effects of PRP relevant to orthopedic surgery have rarely been addressed. In this review, we will discuss recent developments regarding PRP preparations and potential therapeutic effects. Additionally, we present a synopsis of several published data regarding PRP applications in orthopedic surgery for treating tendon injuries, inducing bone repair, strengthening spinal fusion outcomes, and supporting major joint replacements.

Two-Year Clinical and Radiographic Outcomes of Expandable Interbody Spacers Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Study.

BACKGROUND: The advantages of minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF) are well documented and include decreased blood loss, shorter length of hospital stay, and reduced perioperative costs. Clinical evidence for the use of expandable interbody spacers in conjunction with MIS TLIF, however, is scarce. This study sought to examine the clinical and radiographic outcomes of patients undergoing MIS TLIF with an expandable spacer. METHODS: Forty patients from 4 institutions who underwent MIS TLIF with an expandable spacer were included in this study and followed for 24 months. Investigator assessment of the surgical technique was reported. Patient self-reported outcomes included Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Short Form 36 (SF-36) physical and mental component scores. Disc height, foraminal height, segmental and lumbar lordosis, and fusion were also assessed. RESULTS: Investigators reported that intraoperative insertion, impaction, number of passes through the neural structures, and fit were better with an expandable spacer than a static spacer. Significant improvements in VAS, ODI, and SF-36 were reported as early as 6 weeks postoperatively and maintained through 24 months. Mean intervertebral and foraminal heights improved significantly from the preoperative time interval to as early as 6 weeks postoperatively and maintained through 24 months. There were no cases of spacer migration, subsidence, or collapse. CONCLUSIONS: The use of an expandable interbody spacer in combination with MIS TLIF resulted in positive investigator assessments, immediate and progressive symptom relief, significant radiographic improvements, and no spacer-related complications.

Normal and abnormal imaging findings in lumbar total disk replacement: devices and complications.

Fusion, with or without laminectomy, is the standard treatment for symptomatic lumbar degenerative disk disease when conservative management has failed. Yet even radiographically verified solid fusion may be accompanied by considerable long-term problems, including recurrent low back pain, spinal stenosis, hypertrophic facet disease, pseudarthrosis, and spondylolysis and spondylolisthesis at adjacent levels. Several studies have shown a relationship between solid fusion and the development of adjacent-level disk disease, which is thought to result from increased stress on, or hypermobility of, adjacent segments. Total disk replacement (TDR) was developed as a way to restore normal mobility of the diseased segments and improve clinical outcomes by decreasing the risk of adjacent-level degenerative disease and related complications. However, like fusion, TDR is associated with various complications; some of these (eg, migration, subsidence) may occur regardless of the device used, whereas others (eg, extrusion of the polyethylene inlay, vertical fractures) are device specific. Facet arthrosis, device wear, particle disease, adjacent-level degeneration, and heterotopic ossification also have been observed after TDR, but the frequency and importance of these findings remain uncertain. Given the increasing use of lumbar TDR to treat degenerative disk disease, it is important that radiologists be familiar with the most commonly used devices and the potential complications of their use.