Regenerative Medicine for Axial and Radicular Spine‐Related Pain: A Narrative Review

Abstract

Introduction Regenerative injection‐based therapy has established itself as a therapeutic option for the management of a variety of painful musculoskeletal conditions. The aim of this work was to review the current literature regarding regenerative injection therapy for axial/radicular spine pain. Methods A comprehensive literature review was conducted on the use of regenerative medicine for axial/radicular spine pain. Eligible articles analyzed the therapeutic injection effects of platelet‐rich plasma (PRP), prolotherapy, or mesenchymal signaling cells (MSCs) via intradiscal, facet joint, epidural, or sacroiliac joint delivery. Results Regarding intradiscal PRP, there are level I/IV studies supporting its use. Regarding intradiscal prolotherapy, there are level III to IV studies supporting its use. Regarding intradiscal MSCs, there are level I/IV studies supporting its use with the exception of one level IV study that found no significant improvement at 12 months. Regarding facet joint injections with PRP, there are level I/IV studies supporting its use. Regarding facet joint injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate any statistical significance supporting its use. Regarding epidural injections with PRP, there are level I/IV studies supporting its use. Regarding epidural injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate statistical significance beyond 48 hours. Regarding sacroiliac joint injections with PRP, there are level I/IV studies supporting its use. Regarding sacroiliac joint injections with prolotherapy, there are level I/III studies supporting its use. Conclusions Currently, there are level I studies to support the use of PRP and MSC injections for discogenic pain; facet joint injections with PRP; epidural injections of autologous conditioned serum and epidural prolotherapy; and PRP and prolotherapy for sacroiliac joint pain. One level I study showed that facet joint prolotherapy has no significant benefit. Notably, no intervention has multiple published level I studies.

Autologous BMAC Therapy Improves Spinal Degenerative Joint Disease in Lower Back Pain Patients

“…Although BMAC administration was demonstrated to be clinically safe and promising for several orthopedic conditions including IDD (18,21,30,39), no studies addressed or supported its use for facetogenic chronic LBP. In fact, all studies targeting facet joint-mediated pain were conducted using platelet rich plasma or prolotherapy (24). As such, we evaluated in this study the therapeutic effect of lumbar injection using autologous BMAC (1-5 ml per structure per level) in patients with chronic LBP.…”

“…Nevertheless, current clinical evidence remains of low quality due to the paucity of high-level randomized, controlled trials; the unstandardized treatment preparation and dosing; the differences in patients' baseline disease grade; and the variability in follow-up measurements (18,19). Most spinal DJD studies have also sought to target IVD with MSC/BMAC injections, leaving other spinal structures involved in DJD like facet joints, intertransversarii muscles, and interspinous ligaments out of scope (24).…”

Plasma rico en factores de crecimiento (PRGF) en la ortopedia, un camino hacia la ortobiología en México

“…El tratamiento se realiza en facetas, foráminas, ramo medial, ligamentos supra e interespinoso y aplicación intramuscular del plasma pobre en plaquetas (PPP) en multifidus. 50 Todo ello guiado con una combinación de fluoroscopia y ultrasonido. 51 En www.medigraphic.org.mx casos de canal lumbar estrecho la aplicación de PRP por vía epidural caudal brinda mejoría importante en el control del dolor.…”

Unproven Regenerative Medicine “Therapies” in Spine

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We congratulate Desai et al 1 on their comprehensive review on regenerative injection-based therapy for spinal axial or radicular pain.However, we would like to highlight the growing problem that many unproven regenerative medicine procedures are uncontrolled experimental "therapies" with a financial, physical, and mental burden. 2 This field carries the potential of exciting science and translational medicine; nevertheless, there is doubt as to safety and efficacy of many of these therapies.

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“…We congratulate Desai et al 1 on their comprehensive review on regenerative injection-based therapy for spinal axial or radicular pain.…”