Transforaminal Endoscopic Lumbar Discectomy with versus without Platelet-Rich Plasma Injection for Lumbar Disc Herniation: A Prospective Cohort Study

Abstract

Objective. Transforaminal endoscopic lumbar discectomy (TELD) is an effective treatment for patients with lumbar disc herniation (LDH) with failure of conservative treatment. However, defects in the annulus fibrosus after TELD usually lead to a recurrence of LDH. Platelet-rich plasma (PRP) injection has shown promising potential for the repair of injured tissues. The combination of TELD and PRP injection has rarely been reported. Hence, this study aimed to evaluate the effectiveness, disc remodeling, and recurrence rate of LDH in TELD with or without PRP in LDH treatment. Methods. A total of 108 consecutive patients who underwent TELD were prospectively registered between July 2018 and December 2019 (https://clinicaltrials.gov/ct2/show/ChiCTR1800017228). Fifty-one and fifty-seven patients underwent TELD with PRP injections and TELD only, respectively. The visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria were evaluated, and perioperative complications were documented. The disc protrusion, spinal cross-sectional area (SCSA), and disc height were measured on MRI and evaluated preoperatively, postoperatively, and at regular follow-up. Results. All patients were followed up. Clinical improvement was noted in both groups. There were statistical differences in the VAS scores of back and leg pain and ODI between the two groups at 3 months, 6 months, and 1 year follow-up ( P < 0.05 ); the improvement in the PRP group was significant. The disc protrusion and SCSA on MRI in the PRP group showed better improvement, with lower recurrence rate, than that in the control group at the final follow-up ( P < 0.05 ). No adverse events were reported in our study following PRP injection. Conclusion. Our study showed that TELD with PRP injection was a safe and effective treatment for patients with LDH in the medium and long-term follow-up. PRP injection was beneficial for disc remodeling after endoscopic discectomy and decreased the recurrence of LDH.

Annulus Fibrosus Repair for Lumbar Disc Herniation: A Meta-Analysis of Clinical Outcomes From Controlled Studies

“…Subsequently, 1 article that was repeated, 1 article was a review, three articles that did not have a control group, two articles that were unqualified for comparison, 1 article that was unqualified for results, and 18 articles involving the same study populations were excluded. Ultimately, 7 randomized controlled studies [18][19][20][21][22][23][24] and 8 observational studies [25][26][27][28][29][30][31][32] matched the inclusion criteria. A flowchart is shown in Figure 1.…”

“…31,39,40 In a three-arm study by Li et al, 22 patients in the trial group received both autologous conditioned plasma (ACP) and AFS. ACP, a type of PRP, was also applied in an observational study by Jiang et al 26 Activated platelets release growth factors and downregulate several inflammatory factors that can promote the repair of different injuries. 22 In a three-arm study by Xu et al, 24 the second trial group received AFS and bone mesenchymal stem cells (BMSCs), which can effectively promote tissue repair.…”

“…Thirteen articles, 18,19,21,[23][24][25][26][27][28][29][30][31][32] with a total of 14 control groups, reported reoperation rates associated with reherniation as the end point of follow-up.…”

“…All 10 studies reported postoperative ODI scores, [18][19][20][21][22]26,[28][29][30]32 and there was a total of 11 control groups. For literature using standard errors and 95% CI, we performed the corresponding data transformation using relevant statistical methods.…”

Autologous Platelet-Rich Plasma Administration on the Intervertebral Disc in Low Back Pain Patients with Modic Type 1 Change: Report of Two Cases

“…Zhang et al reported PRP intraarticular injections reduced pain more effectively than HA injections in knee OA patients at 6 and 12 months after injection [ 23 ]. Furthermore, there are several reports of PRP administered into the intervertebral discs in patients with LBP, but the effects are varied [ 24 , 25 , 26 , 27 , 28 , 29 ]. Some of these studies diagnosed discogenic pain with discography, but given the multifactorial nature of LBP, it is possible that these patients’ LBP included in these previous reports may not be based on intervertebral disc degeneration.…”