Platelet-Rich Plasma: A Safe and Cost-Effective Dural Sealant in Spinal Surgeries: A Systematic Review

Abstract

Objective: Incidental durotomy is a common complication of lumbar spinal surgery and may lead to cerebrospinal fluid (CSF) leakage and associated morbidity. While primary suturing remains the standard method of dural repair, adjunctive sealants are frequently used to achieve watertight closure, though their cost and variable effectiveness limit universal applicability. Platelet-rich plasma (PRP) has demonstrated adhesive and regenerative properties and has been proposed as a potential autologous adjunct for dural repair. This systematic review evaluates the existing evidence on PRP use for CSF leak management and dural closure in spinal procedures.

Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted in accordance with PRISMA guidelines. Studies assessing PRP or platelet-rich fibrin for CSF leak management or dural closure in spinal or dural repair contexts were included. Study characteristics, methodology, and reported outcomes were extracted and analyzed qualitatively.

Results: Six studies met the inclusion criteria, comprising in vitro experiments, animal models, retrospective observational reports, and clinical case reports. Preclinical studies demonstrated improved biomechanical integrity of dural closure and enhanced histological dural healing following PRP application. Clinical evidence was limited to small observational reports and case studies with variable outcomes. No randomized controlled trials or comparative clinical studies evaluating PRP for spinal incidental durotomy were identified.

Conclusion: Current evidence suggests the biological feasibility of PRP as an autologous adjunct for dural repair; however, available data are limited by heterogeneous study designs and low-level clinical evidence. No definitive conclusions regarding clinical effectiveness, safety, or cost-effectiveness can be drawn at present. Well-designed prospective comparative trials in incidental lumbar durotomy specifically are required before PRP can be recommended for routine use in spinal dural closure.

Cite this article as: Aziz HF, Yaqoob U, Tariq R, Shamim MS. Platelet-rich plasma: A safe and cost-effective dural sealant in spinal surgeries: A systematic review. Cerrahpaşa Med J. 2026, 50, 0044, doi: 10.5152/cjm.2026.25044.