A Regenerative Interventional Approach to the Management of Degenerative Low Back Pain

Abstract

Objective: Low back pain has been strongly related to the degenerative process of the spine, especially the degeneration of the intervertebral disc and facet joints. The main procedures for the management of low back pain are no intended to slow down or reverse the degenerative process. Platelet Rich Plasma (PRP), an orthobiologic product, has been the subject of several studies in the management of low back pain. Methods: A prospective case series study presenting the clinical results of 23 patients treated with PRP injections performed following clinical a interventionist protocol called PerMuTIS – Personalized Multi Target Biologic Injection of the Spine. The method to obtain the platelet concentrate was the Simple Double Spin technique, a low-cost double spin that produces Leucocyte Rich PRP. Baseline scores of pain and disability using the Visual Analog Scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) were recorded. Results: Mean VAS pain score across the cohort decreased by approximately 62%, while the Roland-Morris disability score decreased by about 60% at 52 weeks. There was no report of adverse events. The Leucocite and Monocite Rich PRP product showed concentration of 4.3X above baseline, with monocites concentration of 3.2X baseline. Conclusion: The concept of application in multiple targets using a simple and low-cost preparation technique proved to be feasible and without reports of serious side effects that compromise its indication. The PerMuTIS – Personalized Multi Target Biologic Injection in the Spine Technique using Simple Double Spin protocol demonstrated safety and feasibility in this prospective study of patients with low back pain who failed conservative treatments. Large scale, multicenter randomized clinical trial will provide an appropriate level of evidence to assist in clinical practice.

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.…”

“…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]. The combined number of patients in both tables amounts to 1759 individuals.…”

“…(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.…”