Systematic Review of Platelet-Rich Plasma for Low Back Pain

Abstract

Background: Low back pain (LBP) has a high economic burden and is strongly related to the degenerative process of the spine, especially in the intervertebral disc and of the facet joints. Numerous treatment modalities have been proposed for the management of LBP, and the use of platelet-rich plasma (PRP) has emerged as an innovative therapeutic option for degenerative disease of the spine. The present study aims to evaluate the efficacy of PRP injections in managing low back pain. Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a registered at PROSPERO Systematic Reviews Platform, under number CRD42021268491. The PubMed, Web of Science, and Scopus databases were searched to identify relevant articles, along with hand searching to identify gray literature articles, with no language restrictions. Randomized clinical trials (RCTs), nonrandomized trials (NRTs), and case series (CSs) with more than 10 patients were considered eligible. The quality assessment and the risk of bias of the randomized clinical trials were evaluated using the RoB II tool. An evaluation of the description of the preparation methods was performed using an adapted version of the MIBO checklist. Results: An electronic database search resulted in 2324 articles, and after the exclusion of noneligible articles, 13 RCTs and 27 NRTs or CSs were analyzed. Of the 13 RCTs, 11 found favorable results in comparison to the control group in pain and disability, one showed no superiority to the control group, and one was discontinued because of the lack of therapeutic effect at eight-week evaluation. Description of the PRP preparation techniques were found in almost all papers. The overall risk of bias was considered high in 2 papers and low in 11. An adapted MIBO checklist showed a 72.7% compliance rate in the selected areas. Conclusions: In this systematic review, we analyzed articles from English, Spanish and Russian language, from large databases and grey literature. PRP was in general an effective and safe treatment for degenerative LPB. Positive results were found in almost studies, a small number of adverse events were related, the risk of bias of the RCTs was low. Based on the evaluation of the included studies, we graded as level II the quality of the evidence supporting the use of PRP in LBP. Large-scale, multicenter RCTs are still needed to confirm these findings.

Therapeutic factors and biomaterial-based delivery tools for degenerative intervertebral disc repair

“…Meanwhile, according to reports, platelet-rich plasma injection therapy for lower back pain showed significant improvements in functional outcomes, pain relief, and patient satisfaction compared to placebo (intradiscal contrast agent). It is worth noting that patients who receive platelet-rich plasma injections can still alleviate pain and improve function even after several years of injection, while some surgical patients experience recurrent symptoms and are considered to have failed treatment ( Machado et al, 2023 ).…”

Injections of Platelet-Rich Plasma: An Emerging Novel Biological Cure for Low Back Pain?

“…Furthermore, a decrease was observed in the Oswestry Disability Index at the 24-week point. The quality of the evidence recommending PRP therapy for LBP has been graded as level II by Machado ES et al [ 1 ]. Centeno C et al's study demonstrated that platelet lysate epidural injections have been promised as a treatment for lumbar radicular pain.…”

“…Musculoskeletal disorders are a major cause of disability and a substantial financial burden on society [ 1 ]. This illness is more expensive than several other diseases when it comes to both direct as well as indirect costs like reduced productivity and retirement at an early stage.…”

“…This illness is more expensive than several other diseases when it comes to both direct as well as indirect costs like reduced productivity and retirement at an early stage. One of the most common musculoskeletal disorders that causes years of healthy life loss due to disability (YLD) in the general community is low back pain (LBP) [ 1 ]. Most of the time, there are multiple contributing factors to LBP, including facet joints, spinal ligaments, the vertebral periosteum, the central cord, and spinal nerve roots.…”

Histopathology of the Intervertebral Disc of Nothobranchius furzeri, a Fish Model of Accelerated Aging

“…Degenerative processes of the spine not only include OA of the facet joints but also alterations of the intervertebral discs [10][11][12]. In the early phases of disc degeneration a balance shift of anabolic and catabolic activity of extracellular matrix molecules and chondrocytes occurs, which also involves the presence of pro-inflammatory cytokines, including IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, interferon-γ and TNFα [13,14].…”