Combination of percutaneous endoscopic lumbar discectomy and platelet-rich plasma hydrogel injection for the treatment of lumbar disc herniation

Abstract

Objective To determine the safety and efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) hydrogel injection in patients with lumbar disc herniation (LDH). Methods A total of 98 consecutive patients with LDH who underwent either PELD combined with PRP hydrogel injection or PELD alone were reviewed. This retrospective study was performed between January 2019 and January 2021. Clinical outcomes were compared in the visual analog scale (VAS) for low back pain and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) scores, and Macnab criteria. Intervertebral disc height on MRI was measured, and the Pfirrmann grade classification was used pre-operatively and post-operatively. Results No severe adverse events were reported during an 18-month follow-up period. VAS scores for back pain were decreased at 1 month, 3 months, and 18 months in the treatment group than that in the control group. JOA score and ODI in the treatment group at 3-month and 18-month follow-up was lower than that in the control group (P < 0.05). The excellent and good rate of the Macnab criteria was 92.0% (46/50) in the treatment group and 89.6% (43/48) in the control group (P > 0.05). The comparison of Pfirrmann grading and disc height at 18-month follow-up showed significant difference in two groups (P < 0.05). The recurrence of LDH in the treatment group was lower than that in the control group (P < 0.05). Conclusions We suggest that PELD combined with PRP hydrogel injection to treat patients with LDH is a safe and promising method. PRP injection was beneficial for disc remodelling after PELD.

Percutaneous endoscopic lumbar discectomy combined with platelet-rich plasma injection for lumbar disc herniation: analysis of clinical and imaging outcomes

“…In terms of clinical research, Akeda et al [ 16 ] conducted an initial clinical trial in 2011, providing the first evidence that intra-disc application of autologous PRP is an effective treatment for degenerative disc diseases. Since then, numerous scholars have reported the application of PRP in alleviating back pain and neurogenic symptoms, with sustained long-term clinical effects [ 1 , 13 , 17 ]. In our study, patients treated with PRP injection demonstrated a greater advantage in terms of pain relief and neurological function improvement, aligning with the outcomes of previous trials.…”

“…Lumbar disc herniation (LDH) is a common spinal disease in clinical practice, showing a developing trend of low age and high incidence [ 1 ]. For patients with mild symptoms, conservative treatment can alleviate the symptoms, but surgical intervention is still required for patients who do not respond to conservative treatment [ 2 ].…”

“…At present, spinal endoscopy combined with PRP for the treatment of LDH is attracting increasing clinical attention. In previous studies, Zhang [ 1 ] and Jiang [ 13 ] reported that endoscopic discectomy combined with PRP for LDH could achieve satisfactory clinical outcomes. However, the evidence for PRP to delay disc degeneration and promote disc remodeling is still limited, especially in terms of imaging.…”

The Clinical Efficacy of Platelet-Rich Plasma Injection Therapy versus Different Control Groups for Chronic Low Back Pain: A Network Meta-Analysis of Randomized Controlled Trials

“…It contains higher levels of cytokines and growth factors that can promote angiogenesis, accelerate endothelial regeneration, stimulate tissue repair and healing processes, and increase collagen content in different types of tissues. [34][35][36][37][38] When platelets are activated in PRP, they can produce many growth factors, including platelet-derived growth factor, basic fibroblast growth factor, transforming growth factor-β, insulin-like growth factor, vascular endothelial growth factor, etc. They can promote the production of collagen II and chondrocytes, prevent apoptosis of mesenchymal stem cells and chondrocytes, and avert the catabolic effects of inflammatory cytokines like interleukin-1β and matrix metalloproteinase.…”