Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial

Levi, David; Horn, Scott; Tyszko, Sara; Levin, Josh; Hecht-Leavitt, Charles; Walko, Edward

doi:10.1093/pm/pnv053

Cited by 77 publications

(105 citation statements)

References 70 publications

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“…Several studies have demonstrated improvement in clinical scores including ODI, VAS, and JOA beginning 1 month post-PRP injection [64][65][66][67]. Additionally, these studies have reported no complications associated with MSC and PRP injections [64].…”

Section: Treatment Non-operativementioning

confidence: 95%

Lumbar Disc Herniation

Amin

Andrade

Neuman³

2017

Curr Rev Musculoskelet Med

244

202

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Purpose of Review Substantial advancements have been made in the cause, diagnosis, imaging, and treatment options available for patients with lumbar disc herniation (LDH). We examined the current evidence and highlight the concepts on the frontline of discovery in LDH. Recent Findings There are a myriad of novel etiologies of LDH detailed in recent literature including inflammatory factors and infectious microbes. In the clinical setting, recent data focuses on improvements in computer tomography as a diagnostic tool and non-traditional injection options including tumor necrosis alpha inhibitors and platelet-rich plasma. Operative treatment outcomes have focused on minimally invasive endoscopic approaches and demonstrated robust 5-year post-operative outcomes. Summary Advances in the molecular etiology of LDH will continue to drive novel treatment options. The role of endoscopic treatment for LDH will continue to evolve. Further research into10-year outcomes will be necessary as this surgical approach continues to gain widespread popularity.

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Section: Treatment Non-operativementioning

confidence: 95%

Lumbar Disc Herniation

Amin

Andrade

Neuman³

2017

Curr Rev Musculoskelet Med

244

202

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“…Levi et al studied 22 patients who underwent intradiscal PRP injection with a 6-month follow-up. Categorical success rate rose from 14% at 1 month, 32% at 2 months, to 47% at 6 months of at least 50% improvement 78. A prospective, double-blinded, randomized, placebo controlled study of 47 patients showed significant improvement outcomes in the intradiscal injected PRP group with regard to pain.…”

Section: Introductionmentioning

confidence: 94%

Treatment of chronic low back pain – new approaches on the horizon

Knežević¹,

Mandalia²,

Raasch³

et al. 2017

JPR

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Back pain is the second leading cause of disability among American adults and is currently treated either with conservative therapy or interventional pain procedures. However, the question that remains is whether we, as physicians, have adequate therapeutic options to offer to the patients who suffer from chronic low back pain but fail both conservative therapy and interventional pain procedures before they consider surgical options such as discectomy, disc arthroplasty, or spinal fusion. The purpose of this article is to review the potential novel therapies that are on the horizon for the treatment of chronic low back pain. We discuss medications that are currently in use through different phases of clinical trials (I–III) for the treatment of low back pain. In this review, we discuss revisiting the concept of chemonucleolysis using chymopapain, as the first drug in an intradiscal injection to reduce herniated disc size, and newer intradiscal therapies, including collagenase, chondroitinase, matrix metalloproteinases, and ethanol gel. We also review an intravenous glial cell-derived neurotrophic growth factor called artemin, which may repair sensory nerves compressed by herniated discs. Another new drug in development for low back pain without radiculopathy is a subcutaneous monoclonal antibody acting as nerve growth factor called tanezumab. Finally, we discuss how platelet-rich plasma and stem cells are being studied for the treatment of low back pain. We believe that with these new therapeutic options, we can bridge the current gap between conservative/interventional procedures and surgeries in patients with chronic back pain.

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“…Optimization of indication (to distinguish responders and nonresponders), cell‐source, cell concentration, and scaffold type are needed, as are larger‐scale clinical trials to show long‐term safety and efficacy. Intradiscal PRP injection seems safe; however, its efficacy remains unclear . Chondrocyte transplantation studies showed some positive results in a small number of participants; further studies are needed to show efficacy .…”

Section: Available Clinical Treatments For Discogenic Painmentioning

confidence: 99%

Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment

et al. 2019

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Discogenic back pain is multifactorial; hence, physicians often struggle to identify the underlying source of the pain. As a result, discogenic back pain is often hard to treat—even more so when clinical treatment strategies are of questionable efficacy. Based on a broad literature review, our aim was to define discogenic back pain into a series of more specific and interacting pathologies, and to highlight the need to develop novel approaches and treatment strategies for this challenging and unmet clinical need. Discogenic pain involves degenerative changes of the intervertebral disc, including structural defects that result in biomechanical instability and inflammation. These degenerative changes in intervertebral discs closely intersect with the peripheral and central nervous systems to cause nerve sensitization and ingrowth; eventually central sensitization results in a chronic pain condition. Existing imaging modalities are nonspecific to pain symptoms, whereas discography methods that are more specific have known comorbidities based on intervertebral disc puncture and injection. As a result, alternative noninvasive and specific diagnostic methods are needed to better diagnose and identify specific conditions and sources of pain that can be more directly treated. Currently, there are many treatments/interventions for discogenic back pain. Nevertheless, many surgical approaches for discogenic pain have limited efficacy, thus accentuating the need for the development of novel treatments. Regenerative therapies, such as biologics, cell‐based therapy, intervertebral disc repair, and gene‐based therapy, offer the most promise and have many advantages over current therapies. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research

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Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial

Abstract: This trial demonstrates encouraging preliminary 6 month findings, using strict categorical success criteria, for intradiscal PRP as a treatment for presumed discogenic low back pain. Randomized placebo controlled trials are needed to further evaluate the efficacy of this treatment.

Cited by 77 publications

References 70 publications

Lumbar Disc Herniation

Lumbar Disc Herniation

Treatment of chronic low back pain – new approaches on the horizon

Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment

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Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial

Abstract: This trial demonstrates encouraging preliminary 6 month findings, using strict categorical success criteria, for intradiscal PRP as a treatment for presumed discogenic low back pain. Randomized placebo controlled trials are needed to further evaluate the efficacy of this treatment.

Cited by 77 publications

References 70 publications

Lumbar Disc Herniation

Lumbar Disc Herniation

Treatment of chronic low back pain &ndash;&nbsp;new approaches on the horizon

Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment

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Product

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Treatment of chronic low back pain – new approaches on the horizon