Case Series

Effectiveness of plasma rich in growth factors in the management of chronic spinal pain: a case series of 32 patients

*Author for correspondence: Tel.: +39 02 6621 4067;

E-mail Address: maldischiena@me.com

https://orcid.org/0000-0003-3547-7186

IRCCS Istituto Ortopedico Galeazzi, Terapia del Dolore Interventistica, Milan, 20161, Italy

‡Joint first authors

Search for more papers by this author

Alessandra Colombini^‡

https://orcid.org/0000-0002-1800-3424

IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all'Ortopedia, Milan, 20161, Italy

‡Joint first authors

Search for more papers by this author

Agnes Stogicza

https://orcid.org/0000-0001-8045-9185

St Magdolna Private Hospital, Department of Anesthesiology & Pain Medicine, Budapest, 1123, Hungary

Search for more papers by this author

Laura de Girolamo

https://orcid.org/0000-0002-9979-3092

IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all'Ortopedia, Milan, 20161, Italy

Search for more papers by this author

Published Online:24 Jan 2022https://doi.org/10.2217/rme-2021-0128

View article

Abstract

Background: This prospective, case-series study aimed to assess the clinical effectiveness of plasma rich in growth factors (PRGF) in patients with chronic low back pain (LBP) and to identify the features of the responsive patients. Materials & methods: PRGF was injected into the intervertebral disc, epidural space and/or facet and sacroiliac joints of 32 patients with chronic LBP. The efficacy of the treatment was assessed by algo-functional scores after 3 and 6 months. Results: Overall, the patients did not ameliorate after PRGF treatment, although eight patients showed an algo-functional improvement. They were mainly males treated at two sites who were younger, less sedentary and with fewer musculoskeletal co-morbidities than the nonresponders. Conclusion: PRGF is a potential treatment in a specific subpopulation of difficult-to-treat patients affected by chronic LBP.

Plain language summary

In this study, 32 patients with chronic low back pain (LBP) were treated with plasma rich in growth factors (PRGF) to evaluate its clinical efficacy up to 6 months. The results showed that, analyzing the total cohort, the PRGF did not ameliorate the patients' conditions. However, eight patients responded to the treatment by showing an algo-functional improvement. They were mainly males, younger than 50 years/old, with active lifestyle habits, and with less musculoskeletal co-morbidities than the patients who did not respond. Best results were obtained when PRGF was injected at one intervertebral disc plus facet joints at the corresponding level. In conclusion, PRGF may be an effective treatment if used in patients with specific characteristics.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

References

1. Manchikanti L, Abdi S, Atluri S et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 16(Suppl. 2), S49–S283 (2013).
MedlineGoogle Scholar
2. Navani A, Manchikanti L, Albers SL et al. Responsible, safe, and effective use of biologics in the management of low back pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician 22(Suppl. 1), S1–S74 (2019). •• This is a reference document with guidelines for the use of biologics for low back pain management.
MedlineGoogle Scholar
3. Amirdelfan K, Webster L, Poree L, Sukul V, Mcroberts P. Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach. Spine 42(Suppl. 14), S41–S52 (2017).
MedlineGoogle Scholar
4. Manchikanti L, Benyamin RM, Falco FJ, Hirsch JA. Recommendations of the Medicare Payment Advisory Commission (MEDPAC) on the health care delivery system: the impact on interventional pain management in 2014 and beyond. Pain Physician 16(5), 419–440 (2013).
MedlineGoogle Scholar
5. Martinez CE, Smith PC, Palma Alvarado VA. The influence of platelet-derived products on angiogenesis and tissue repair: a concise update. Front. Physiol. 6, 290 (2015).
MedlineGoogle Scholar
6. Akeda K, Yamada J, Linn ET, Sudo A, Masuda K. Platelet-rich plasma in the management of chronic low back pain: a critical review. J. Pain Res. 12, 753–767 (2019). • A recent review on the use of platelet rich plasma for low back pain management.
Medline CASGoogle Scholar
7. Sanapati J, Manchikanti L, Atluri S et al. Do regenerative medicine therapies provide long-term relief in chronic low back pain: a systematic review and metaanalysis. Pain Physician 21(6), 515–540 (2018).
MedlineGoogle Scholar
8. Bhatia R, Chopra G. Efficacy of platelet rich plasma via lumbar epidural route in chronic prolapsed intervertebral disc patients – a pilot study. J. Clin. Diagn. Res. 10(9), UC05–UC07 (2016).
Google Scholar
9. Centeno C, Markle J, Dodson E et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J. Exp. Orthop. 4(1), 38 (2017).
MedlineGoogle Scholar
10. Ravi Kumar HS, Goni V, Batra YK. Autologous conditioned serum as a novel alternative option in the treatment of unilateral lumbar radiculopathy: a prospective study. Asian Spine J. 9(6), 916–922 (2015).
MedlineGoogle Scholar
11. Akeda K, Ohishi K, Masuda K et al. Intradiscal injection of autologous platelet-rich plasma releasate to treat discogenic low back pain: a preliminary clinical trial. Asian Spine J. 11(3), 380–389 (2017).
MedlineGoogle Scholar
12. Kirchner F, Anitua E. Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain. J. Craniovert. Jun. Spine 7(4), 250–256 (2016).
MedlineGoogle Scholar
13. Levi D, Horn S, Tyszko S, Levin J, Hecht-Leavitt C, Walko E. Intradiscal platelet-rich plasma injection for chronic discogenic low back pain: preliminary results from a prospective trial. Pain Med. 17(6), 1010–1022 (2016).
MedlineGoogle Scholar
14. Tuakli-Wosornu YA, Terry A, Boachie-Adjei K et al. Lumbar intradiskal platelet-rich plasma (PRP) injections: a prospective, double-blind, randomized controlled study. PM & R 8(1), 1–10; quiz 10 (2016).
MedlineGoogle Scholar
15. Monfett M, Harrison J, Boachie-Adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int. Orthop. 40(6), 1321–1328 (2016).
MedlineGoogle Scholar
16. Cheng J, Santiago KA, Nguyen JT, Solomon JL, Lutz GE. Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5–9 years. Regen. Med. 14(9), 831–840 (2019).
CASGoogle Scholar
17. Navani A, Gupta D. Role of intra-articular platelet-rich plasma in sacroiliac joint pain. Reg. Anesth. Pain Med. 19, 54–59 (2015).
Google Scholar
18. Navani A, Ambach MA, Navani R, Wei J. Biologics and lumbar discogenic pain: 18 month follow-up for safety and efficacy. IPM Reports 2, 111–118 (2018).
Google Scholar
19. Wu J, Du Z, Lv Y et al. A new technique for the treatment of lumbar facet joint syndrome using intra-articular injection with autologous platelet rich plasma. Pain Physician 19(8), 617–625 (2016).
MedlineGoogle Scholar
20. Manchikanti L, Soin A, Mann DP, Bakshi S, Pampati V, Hirsch JA. Comparative analysis of utilization of epidural procedures in managing chronic pain in the Medicare population: pre and post Affordable Care Act. Spine 44(3), 220–232 (2019). • A recent document on the use of epidural procedures for low back pain management.
MedlineGoogle Scholar
21. Basso M, Cavagnaro L, Zanirato A et al. What is the clinical evidence on regenerative medicine in intervertebral disc degeneration? Musculoskeletal Surg. 101(2), 93–104 (2017).
Medline CASGoogle Scholar
22. Wu T, Song HX, Dong Y, Li JH. Cell-based therapies for lumbar discogenic low back pain: systematic review and single-arm meta-analysis. Spine 43(1), 49–57 (2018).
MedlineGoogle Scholar
23. Wu J, Zhou J, Liu C et al. A prospective study comparing platelet-rich plasma and local anesthetic (LA)/corticosteroid in intra-articular injection for the treatment of lumbar facet joint syndrome. Pain Pract. 17(7), 914–924 (2017). • A study comparing platelet rich plasma and standard local treatment of lumbar facet joint syndrome.
MedlineGoogle Scholar
24. Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. platelet-rich plasma in ultrasound-guided sacroiliac joint injection for chronic low back pain. Pain Pract. 17(6), 782–791 (2017).
MedlineGoogle Scholar
25. Lansdown DA, Fortier LA. Platelet-rich plasma: formulations, preparations, constituents, and their effects. Oper. Tech. Sports Med. 25, 7–12 (2017). • Study reporting platelet rich plasma formulations and preparations.
Google Scholar
26. Sanchez M, Anitua E, Cugat R et al. Nonunions treated with autologous preparation rich in growth factors. J. Orthop. Trauma 23(1), 52–59 (2009).
MedlineGoogle Scholar
27. Sanchez M, Delgado D, Pompei O et al. Treating severe knee osteoarthritis with combination of intra-osseous and intra-articular infiltrations of platelet-rich plasma: an observational study. Cartilage 10(2), 245–253 (2019).
MedlineGoogle Scholar
28. Solakoglu O, Heydecke G, Amiri N, Anitua E. The use of plasma rich in growth factors (PRGF) in guided tissue regeneration and guided bone regeneration. A review of histological, immunohistochemical, histomorphometrical, radiological and clinical results in humans. Ann. Anat. 231, 151528 (2020).
MedlineGoogle Scholar
29. Anitua E, Prado R, Azkargorta M et al. High-throughput proteomic characterization of plasma rich in growth factors (PRGF-Endoret)-derived fibrin clot interactome. J. Tissue Eng. Regen. Med. 9(11), e1–e12 (2015).
Medline CASGoogle Scholar
30. Gronblad M, Hupli M, Wennerstrand P et al. Intercorrelation and test-retest reliability of the pain disability index (PDI) and the Oswestry disability questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. Clin. J. Pain 9(3), 189–195 (1993).
Medline CASGoogle Scholar
31. Little DG, Macdonald D. The use of the percentage change in Oswestry disability index score as an outcome measure in lumbar spinal surgery. Spine 19(19), 2139–2143 (1994).
Medline CASGoogle Scholar
32. Ostelo RW, Deyo RA, Stratford P et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33(1), 90–94 (2008).
MedlineGoogle Scholar
33. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J. Manipulative Physiol. Ther. 27(1), 26–35 (2004).
MedlineGoogle Scholar
34. Oder B, Loewe M, Reisegger M, Lang W, Ilias W, Thurnher SA. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease – effect of age, gender, disc pathology and multi-segmental changes. Neuroradiology 50(9), 777–785 (2008).
MedlineGoogle Scholar
35. Deyo RA, Weinstein JN. Low back pain. New Engl. J. Med. 344(5), 363–370 (2001).
Medline CASGoogle Scholar
36. Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop. Clin. North Am. 22(2), 181–187 (1991).
Medline CASGoogle Scholar
37. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine 19(7), 801–806 (1994).
Medline CASGoogle Scholar
38. Nagae M, Ikeda T, Mikami Y et al. Intervertebral disc regeneration using platelet-rich plasma and biodegradable gelatin hydrogel microspheres. Tissue Eng. 13(1), 147–158 (2007).
Medline CASGoogle Scholar
39. Obata S, Akeda K, Imanishi T et al. Effect of autologous platelet-rich plasma-releasate on intervertebral disc degeneration in the rabbit anular puncture model: a preclinical study. Arthritis Res. Ther. 14(6), R241 (2012).
Medline CASGoogle Scholar
40. Sawamura K, Ikeda T, Nagae M et al. Characterization of in vivo effects of platelet-rich plasma and biodegradable gelatin hydrogel microspheres on degenerated intervertebral discs. Tissue Eng. Part A 15(12), 3719–3727 (2009).
Medline CASGoogle Scholar
41. Waddell G. Low back pain: a twentieth century health care enigma. Spine 21(24), 2820–2825 (1996).
Medline CASGoogle Scholar
42. Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR Am. J. Neuroradiol. 24(5), 996–1000 (2003).
MedlineGoogle Scholar
43. Kim YS, Chin DK, Yoon DH, Jin BH, Cho YE. Predictors of successful outcome for lumbar chemonucleolysis: analysis of 3000 cases during the past 14 years. Neurosurgery 51(Suppl. 5), S123–S128 (2002).
MedlineGoogle Scholar
44. Muto M, Andreula C, Leonardi M. Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J. Neuroradiol. 31(3), 183–189 (2004).
Medline CASGoogle Scholar
45. Smith L, Brown JE. Treatment of lumbar intervertebral disc lesions by direct injection of chymopapain. J. Bone Joint Surg. Br. 49(3), 502–519 (1967).
Medline CASGoogle Scholar
46. Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. 4(1), 27–35 (2004).
MedlineGoogle Scholar
47. Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1-year follow-up. Spine 25(20), 2622–2627 (2000).
Medline CASGoogle Scholar
48. Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J. 4(5), 495–505 (2004).
MedlineGoogle Scholar
49. Khot A, Bowditch M, Powell J, Sharp D. The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine 29(8), 833–836; discussion 837 (2004).
MedlineGoogle Scholar
50. Gallucci M, Limbucci N, Zugaro L et al. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology 242(3), 907–913 (2007).
MedlineGoogle Scholar
51. Anitua E, Prado R, Sánchez M, Orive G. Platelet-rich plasma: preparation and formulation. Oper. Tech. Orthop. 22(1), 25–32 (2012). • Study reporting platelet rich plasma formulations and preparations.
Google Scholar
52. Aprili G, Gandini G, Guaschino R et al. SIMTI recommendations on blood components for non-transfusional use. Blood Transfus. 11(4), 611–622 (2013).
MedlineGoogle Scholar

Vol. 17, No. 3

Metrics

Downloaded 90 times

History

Received 8 September 2021

Accepted 12 January 2022

Published online 24 January 2022

Published in print March 2022

Information

Keywords

Author contributions

M Barbieri: substantial contributions to the design of the work, acquisition and interpretation of data; revision of the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work. A Colombini: substantial contributions to the design of the work; acquisition, analysis and interpretation of data; drafting of the work; final approval of the version to be published; agreement to be accountable for all aspects of the work. A Stogicza: interpretation of data for the work; revision of the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work. L de Girolamo: substantial contributions to the design of the work; interpretation of data; revision of the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work.

Acknowledgments

The authors are grateful to A Zagra, IRCCS Istituto Ortopedico Galeazzi, Milano, for precious advice concerning the clinical part of the study and L Angelini for technical support.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations.

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.

Data availability statement

https://osf.io/phsbw/?view_only=647e2fb2f62f434da5b7b10d8ab18e45.

PDF download