May Single One Level Intradiscal Autologous Platelet Rich Plasma Injection Play a Role in the Treatment of Discogenic Pain? Results at Six Month Follow-Up

Abstract

Objective: Low back pain is spreading both in older and younger people in a fast manner. Discogenic pain resulting from degeneration of the intervertebral disc is responsible for 40% or more of the cases of low back pain. We hypothesized that single one level intradiscal autologous platelet rich plasma (PRP) injection might provide remarkable pain relief and return to pre-illness activity level in the patients suffering from discogenic pain. Material and Methods: Twenty-two patients underwent injections of just one 3ml dose of PRP into one intervertebral disc space (single one level intradiscal autologous PRP injection) for discogenic pain. The patients were evaluated by visual analogue score (VAS) and Oswestry Disability Index (ODI) score before intradiscal PRP treatment and at six months after intradiscal PRP treatment. Results: The average pre-treatment VAS and ODI scores were 5.6±1.0 and 55.0% ± 11.6% respectively. The average VAS and ODI scores at six months after intradiscal PRP treatment were 1.3±1.0 and 23.2% ± 11.2% respectively and the differences were statistically significant (p<0.01). Conclusion: The present study demonstrates that single one level intradiscal PRP injection may provide remarkable pain relief and may increase the return to pre-illness activity level in the patients suffering from discogenic pain. For evaluation of the efficacy of this treatment, randomized placebo-controlled trials are needed. Amaç: Bel ağrısı hem genç hem de yaşlı nüfusta gittikçe artan bir oranda görülmektedir. İntervertebral disk dejenerasyonu neticesinde gelişen diskojenik ağrı, kronik bel ağrısı şikayetlerinin yaklaşık %40'ının sebebidir. Bizim bu çalışmadaki hipotezimiz diskojenik ağrı tedavisinde bir seviye tek sefer otolog intradiskal plateletten zengin plazma (PZP) uygulamasının hastaların fiziksel aktiviteye dönüşü ve ağrı üzerinde belirgin bir iyileşme sağlayabileceğidir. Gereç ve Yöntemler: Diskojenik ağrı tedavisi için 22 hastaya bir seviye tek sefer 3ml intradiskal otolog platelet zengin plazma (PZP) uygulaması yapıldı. Hastalar tedavi öncesi ve tedaviden 6 ay sonra vizüel analog skor (VAS) ve Oswestry disabilite index (ODI) ile değerlendirildi. Bulgular: Tedavi öncesi ortalama VAS ve ODI skorları sırası ile 5.6±1.0 ve %55.0 ± %11.6 idi. Tedaviden 6 ay sonra ortalama VAS ve ODI skorları sırası ile 1.3±1.0 ve %23.2 ± %11.2 idi ve fark istatistiksel olarak anlamlı bulundu (p<0.01). Sonuç: Çalışmamız kronik diskojenik ağrı hastalarında bir seviye tek sefer intradiskal PZP uygulamasının hastaların fiziksel aktiviteye dönüşü ve ağrı üzerinde belirgin bir iyileşme sağlayabileceğini göstermiştir. Intradiskal PZP tedavisnin etkinliğini daha derinlemesine araştırmak için randomize plasebo kontrollü çalışmalara ihtiyaç vardır.

The Role of Platelet Rich Plasma in Vertebrogenic and Discogenic Pain: A Systematic Review and Meta-Analysis

“…This suggests PRP may have potential benefits in treating discogenic pain. While some studies support the use of intradiscal PRP for discogenic pain, others have not found significant structural or functional improvement from the included studies [15 Sevgili and Sari observed remarkable pain relief and improved return to pre-illness activity levels with singlelevel intradiscal PRP injections for discogenic pain [17]. However, Akeda et al underscored the necessity for largerscale studies to validate the clinical evidence for PRP in treating discogenic lower back pain [16•].…”

“…Jain et al conducted a prospective clinical trial and concluded that intradiscal PRP injection was effective in treating discogenic low back pain, especially when higher platelet counts were used [24]. Sevgili and Sari investigated the role of single level intradiscal autologous PRP injection in the treatment of discogenic pain and reported remarkable pain relief and improved activity levels in patients [17].…”

Systematic Review of Platelet-Rich Plasma for Low Back Pain

“…One RTC study was still in the peer-review process at the time of analysis and was included as a personal communication to the author [73]. Additionally, the case series involved a total of 1759 patients, with studies focusing on intradiscal (160 patients) [34,56,[79][80][81][82][83], epidural (810 patients) [64,[84][85][86][87][88], facet injection (109 patients) [89][90][91], and lumbar muscles (171 patients) [61,92] or simultaneous application in multiple targets (509 patients) [10,[93][94][95][96][97][98][99][100]. The RCTs compared the effect of PRP with saline, steroids, contrast agent, hyaluronic acid, or ozone.…”

“…In the case series group, a total of 27 articles were found. Table 5 presents 18 papers focusing on specific targets, including the disc (n = 7) [34,56,[79][80][81][82][83], epidural space (n = 6) [64,[84][85][86][87][88], facet joint (n = 3) [89][90][91], and paravertebral muscle (n = 2) [61,92]. On the other hand, Table 6 includes nine papers that explored multitarget applications, involving the disc, facet, epidural space, and/or muscles simultaneously [10,[93][94][95][96][97][98][99][100].…”