ASRA - American Society of Regional Anesthesia and Pain Medicine
Epidural platelet-rich plasma (PRP) for discogenic back pain
Scientific abstract: Chronic pain
*José Correa, **Edwin García, *Patricia Abella, *Augusto Rojas,
*Fundación Universitaria JN Corpas – Bogotá, Colombia
** Universidad UNICOC, Santiago de Cali, Colombia
E-mail to: [email protected]
Intervertebral disc degeneration (IDD) is a chronic disease that causes significant disability and dependence and exerts a high cost on society. IDD is the most common cause of back pain and may involve any segment of the spine. It is one of the most frequent reasons for consultation in the general population, affecting 80-85 % of people throughout life. Current therapeutic strategies are primary conservative, including physical therapy and anti-inflammatory medication. Surgical techniques are intended only to stabilize the spine and/or decompress the spinal or foraminal canal, searching for relieve of symptoms; however, do not address the cause of the degeneration and even accelerate the degeneration of adjacent segments. Understanding of the biology of platelet-rich plasma (PRP) conducted us to the use of PRP as a promising biological therapeutic strategy for enhance the healing and the regenerative process and of the intervertebral disc. Very few clinical studies have been performed linking PRP with the management of IDD, most of them through intradiscal injection of autologous PRP. At present, only anecdotic documents have described epidural PRP injections as a method of intervertebral disc regeneration in cases of IDD, except for our preliminary published study (5) that included 70 patients with IDD, in whom autologous PRP was injected into the epidural space, cervical or lumbar, improving their pain scores and without reported complications in a three-months follow-up.
This new paper is an update of our previous work: here we included 250 patients in a 2 year follow-up. We evaluated whether multiple PRP injections improve the outcome. In addition, MRI variations are being recorded in patients with two or more shots of epidural PRP.
Materials and methods
Prospective observational study carried out between January 2015 and June 2017 where 250 patients with the diagnosis of IDD and refractory to a multimodal pharmacological management for more than 6 months were included. The option of using epidural PRP as an avant-garde technique was explained to each patient. Institutional approval and informed consent were signed by all patients.
All patients received an epidural injection using an 18G-Tuohy needle at cervical level (C6-C7) or lumbar level (L4-L5 or L5-S1). The patients were evaluated in terms of both pain and function using the VAS-scale and the MACNAB-score. 155 patients received one dose epidural-PRP; 80 patients received 2 doses and 15 received 3 doses in 8-to-10 weeks interval.
Mean VAS-scale improved in 85% of patients, from 9 to 3, and mean MACNAB-score was considered GOOD at the end of 6 months follow-up after the PRP injection(s). Positive changes in MRI images 6 months following treatment have been documented in few patients, but this aspect needs further research. 15% of patients did not improve the pain score, however no patient showed a worsening of the symptoms.
Epidural PRP injections for IDD showed clinically significant improvements in pain (VAS-scale) and function (MACNAB-score) through two years of follow-up. Multiple injections improved functional outcome, however, to the best of our knowledge, no clinical studies have so far indicated the number of injections required. MRI changes requires further research.
Conflicts of Interest: None declared.
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