Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopaedic surgery

Study Design: Randomized controlled prospective comparative study of a total number of 50 patients with Failed Back Surgery Syndrome (FBSS) undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Objectives: To study the use of Platelet Rich Fibrin (PRF) combined with autograft in comparison to autograft alone in TLIF for FBSS regarding feasibility, postoperative clinical and radiological outcome, advantages and disadvantages. Methods: Patients were randomly divided into two groups: Control group including 25 patients with FBSS undergoing TLIF using autograft alone and Trial group including 25 patients with FBSS undergoing TLIF using PRF combined with autograft with an average follow up of 12 months, Clinical assessment was done using Visual/Numerical Analogue Scale (VAS/NAS) to assess low back pain and limb pain together with Oswestry Disability Index (ODI) to assess disability preoperative, postoperative and follow up at 1, 3, 6, 9 and 12 months, Radiological assessment was done using X ray AP, lateral and dynamic views together with MRI for preoperative assessment, X ray AP and lateral views for postoperative assessment and X ray AP, lateral views for follow up at 3, 6 and 12 months together with CT scan for follow up at 6 and 12 months. Results: Trial Group showed much more significant improvement in clinical and radiological outcome than Control group with no significant difference in baseline characteristics of patients, operative data and complications either intraoperative or postoperative, from preoperative assessment to last follow up VAS/NAS for back pain, limb pain and ODI improved by a mean of 6.280±1.308SD, 6.240±1.165SD and 59.800±5.859SD respectively for trial group while it improved by a mean of 5.360± 1.036SD, 6.200±1.080SD and 52.600±7.654SD respectively for control group, radiological definite fusion was 32% and 88% at 6 and 12 months follow up respectively for trial group while it was 0% and 60% at 6 and 12 months follow up respectively for control group with definite pseudoarthrosis of 4% in trial group and 20% in control group at 12 months follow up. Conclusion: The use of PRF in TLIF for FBSS is an additional feasible step that improves the clinical and radiological outcome without much more cost or time consumption having its own advantages and disadvantages that requires much more study in the future

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