Efficacy of Epidural Perineural Injections With Autologous Conditioned Serum for Lumbar Radicular Compression

Becker, Cordelia; Heidersdorf, Stefan; Drewlo, Sascha; Rodriguez, Sonja Zirke de; Krämer, J.; Willburger, R. E.

doi:10.1097/brs.0b013e3181076514

Cited by 98 publications

(74 citation statements)

References 14 publications

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“…One RCT compared epidural injections of autologous conditioned serum, rich in anti-inflammatory cytokines, compared with epidural injections of corticosteroid and local anaesthetic [19]. One historical cohort study compared sub-cutaneous injections of etanercept with intra-venous injections of corticosteroid [29] ( Table 2).…”

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

“…Five reported an adequate method of random number generation [19,[21][22][23][24], but only three documented a secure method of allocation concealment [21,25,26]. Three studies had moderately good external validity [21,26,29] (Table 3).…”

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

“…We identified seven RCTs [19][20][21][22][23][24][25][26] one non-RCT [27,28] and one historical cohort study [29]. Two studies were reported in two separate publications each [23,24,27,28].…”

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

“…The nine studies included 412 participants with mean ages between 39 and 54 years, with 40-80 % men, five with acute [21][22][23][24][27][28][29], one with chronic [25] and three with acute and chronic symptom duration [19,20,26] (Tables 1, 2). Three RCTs included patients with recurrent symptoms [21,23,24,29], but symptom recurrence was not reported in six studies [19,20,22,25,26,29]. Sciatica was confirmed by imaging in all studies and previous back surgery was excluded in five trials [22][23][24][25][26][27][28].…”

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

“…Sciatica was confirmed by imaging in all studies and previous back surgery was excluded in five trials [22][23][24][25][26][27][28]. Participants were selected from consecutive outpatient [19] or inpatient attendances [29], after failure to respond to conservative therapy such as physiotherapy and oral analgesia [20,25] or were candidates for disc surgery [22][23][24].…”

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

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A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

et al. 2013

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Purpose Systematic review comparing biological agents, targeting tumour necrosis factor a, for sciatica with placebo and alternative interventions. Methods We searched 21 electronic databases and bibliographies of included studies. We included randomised controlled trials (RCTs), non-RCTs and controlled observational studies of adults who had sciatica treated by biological agents compared with placebo or alternative interventions.Results We pooled the results of six studies (five RCTs and one non-RCT) in meta-analyses. Compared with placebo biological agents had: better global effects in the short-term odds ratio (OR) 2.0 (95 % CI 0.7-6.0), mediumterm OR 2.7 (95 % CI 1.0-7.1) and long-term OR 2.3 [95 % CI 0.5 to 9.7); improved leg pain intensity in the short-term weighted mean difference (WMD) -13.6 (95 % CI -26.8 to -0.4), medium-term WMD -7.0 (95 % CI -15.4 to 1.5), but not long-term WMD 0.2 (95 % CI -20.3 to 20.8); improved Oswestry Disability Index (ODI) in the short-term WMD -5.2 (95 % CI -14.1 to 3.7), mediumterm WMD -8.2 (95 % CI -14.4 to -2.0), and long-term WMD -5.0 (95 % CI -11.8 to 1.8). There was heterogeneity in the leg pain intensity and ODI results and improvements were no longer statistically significant when studies were restricted to RCTs. There was a reduction in the need for discectomy, which was not statistically significant, and no difference in the number of adverse effects. Conclusions There was insufficient evidence to recommend these agents when treating sciatica, but sufficient evidence to suggest that larger RCTs are needed.

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Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

Section: Description Of Biological Agents Studiesmentioning

confidence: 99%

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A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

et al. 2013

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Epidural corticosteroid injections for lumbosacral radicular pain

Oliveira

Maher

Ferreira

et al. 2020

Cochrane Database of Systematic Reviews

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Platelet‐rich plasma and cytokines in neuropathic pain: A narrative review and a clinical perspective

Bohren

Timbolschi

Müller

et al. 2021

European Journal of Pain

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Background and Objective Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. A number of preclinical studies have provided evidence for the involvement of cytokines, predominantly secreted by a variety of immune cells and by glial cells from the nervous system, in neuropathic pain conditions. Clinical trials and the use of anti‐cytokine drugs in different neuropathic aetiologies support the relevance of cytokines as treatment targets. However, the use of such drugs, in particularly biotherapies, can provoke notable adverse effects. Moreover, it is challenging to select one given cytokine as a target, among the various neuropathic pain conditions. It could thus be of interest to target other proteins, such as growth factors, in order to act more widely on the neuroinflammation network. Thus, platelet‐rich plasma (PRP), an autologous blood concentrate, is known to contain a natural concentration of growth factors and immune system messengers and is widely used in the clinical setting for tissue regeneration and repair. Database and Data Treatment In the present review, we critically assess the current knowledge on cytokines in neuropathic pain by taking into consideration both human studies and animal models. Results This analysis of the literature highlights the pathophysiological importance of cytokines. We particularly highlight the concept of time‐ and tissue‐dependent cytokine activation during neuropathic pain conditions. Conclusion Thus, direct or indirect cytokines modulation with biotherapies or growth factors appears relevant. In addition, we discuss the therapeutic potential of localized injection of PRP as neuropathic pain treatment by pointing out the possible link between cytokines and the action of PRP. Significance Preclinical and clinical studies highlight the idea of a cytokine imbalance in the development and maintenance of neuropathic pain. Clinical trials with anticytokine drugs are encouraging but are limited by a 'cytokine candidate approach' and adverse effect of biotherapies. PRP, containing various growth factors, is a new therapeutic used in regenerative medicine. Growth factors can be also considered as modulators of cytokine balance. Here, we emphasize a potential therapeutic effect of PRP on cytokine imbalance in neuropathic pain. We also underline the clinical interest of the use of PRP, not only for its therapeutic effect but also for its safety of use.

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Efficacy of Epidural Perineural Injections With Autologous Conditioned Serum for Lumbar Radicular Compression

Abstract: ACS is an encouraging treatment option for patients with unilateral lumbar radicular compression. The decrease in pain was pronounced, clinically remarkable, and potentially superior to steroid injection.

Cited by 98 publications

References 14 publications

A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

Epidural corticosteroid injections for lumbosacral radicular pain

Platelet‐rich plasma and cytokines in neuropathic pain: A narrative review and a clinical perspective

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