The Effect of Intradiscal Platelet-Rich Plasma Injection for Management of Discogenic Lower Back Pain: A Meta-Analysis

Abstract

Objective Although several researches of animal and human subjects have yielded promising results regarding intradiscal injection of platelet-rich plasma (PRP) for the management of intervertebral disc (IVD) pathologies, small sample sizes and unstandardized graft preparation procedures hampered these research efforts. Therefore, we conducted a meta-analysis to evaluate the effectiveness of intradiscal PRP injection for the treatment of discogenic lower back pain. Methods The PubMed, SCOPUS, Embase, and Cochrane Library databases were systematically searched for relevant studies published from January 01, 1980 to December 14, 2020. The keywords used for the search were (platelet-rich plasma) AND (intradiscal OR back pain OR lumbar spine OR discogenic). Filters were used to select studies with human participants; all study designs were included. Results After the systematic review, three articles, including one randomized control trial and two prospective observational studies, were included in the final analysis. Analysis of changes in visual analogue scale (VAS) scores showed that VAS scores were significantly reduced two and six months after intradiscal PRP injection (two months: standardized mean difference [SMD] = −0.837, 95% CI = −1.158 to −0.516, P < 0.001; six months: SMD = −1.430, 95% CI = −2.209 to −0.652, P < 0.001), but not after one month (SMD = −0.661, 95% CI = −1.346 to 0.023, P = 0.058). Regarding changes in Owestry Disability Index (ODI), ODI scores were significantly reduced after six months (SMD = −0.964, 95% CI = −1.885 to −0.043, P = 0.040). Conclusion Intradiscal PRP injections are effective in relieving pain and improving disabilities caused by discogenic lower back pain. However, the pain-reducing effect significantly manifests two or six months after the injections, but not after one month.

Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain

“…Emerging data have suggested that intradiscal PRP therapy with < fivefold increases in platelet concentrations may have therapeutic value for certain patients with CLDP [ 8 , 13 , 19 , 20 ]. Our results add to the current literature showing long-term benefits of intradiscal PRP in the management of patients with CLDP [ 9 , 14 ].…”

Mesenchymal Stem Cell-Derived Exosomes as a Novel Strategy for the Treatment of Intervertebral Disc Degeneration

“…Several in vivo and in vitro investigations have shown the utility of PRP for IVD repair and regeneration ( Obata et al, 2012 ; Wang et al, 2013 ; Pirvu et al, 2014 ). In addition as a therapeutic strategy, PRP has the merits of being low-cost, ease of preparation, ease of application, and autologous sources without rejection reaction ( Chang and Park, 2021 ). Nevertheless, in view of the possible negative consequences of ossification, inflammation, and vascularization, more research on standardized formulations is of great necessity to validate the effectiveness and safety of PRP.…”

Intradiscal injection for the management of low back pain

“…71 Recently, several meta-analyses demonstrated that intradiscal PRP injection had shown beneficial effects in controlling pain and improving disabilities in patients with LBP, but there was a paucity of high-quality studies to give conclusive evidence. 72,73 Therefore, more clinical studies, especially RCTs with multiple outcome parameters, are necessary for evaluating the true efficacy of this treatment. 74 Moreover, according to the American Society of Interventional Pain Physicians guidelines, the qualitative evidence for intradiscal PRP injection in the treatment of LBP has been assessed as level III, based on the available evidence including RCT, observational studies, metaanalysis, and systematic review.…”

“…Recently, several meta‐analyses demonstrated that intradiscal PRP injection had shown beneficial effects in controlling pain and improving disabilities in patients with LBP, but there was a paucity of high‐quality studies to give conclusive evidence 72,73 . Therefore, more clinical studies, especially RCTs with multiple outcome parameters, are necessary for evaluating the true efficacy of this treatment 74 .…”

“…Prospective trial, prospective randomized controlled trial, systematic review; metaanalysis. [68][69][70][71][72][73][74] Condoliase Specifically dissolve the chondroitin sulfate in NP tissue and relieve the compression on nerve roots.77…”