Platelet rich plasma application in chronic low back pain – clinical and anatomical rationale and review of the literature

Abstract

Low back pain (LBP) is an extremely common symptom in populations of all ages with significant economic and social burden worldwide. As such it should be among the priorities for trying to find more efficient methods for prevention and treatment. Currently the exact cause for the complaints can be found in most of the cases following thorough clinical examination, adequate diagnostic tests and modern image diagnosis. Most often the complaints are cause by degenerative processes affecting certain structures in the lumbosacral area – the intervertebral discs, the tendons/entheses along the iliac crest, the sacroiliac and lumbar facet joints. Platelet rich plasma (PRP) is a widely used therapeutic method aimed at recovering (both anatomical and functional) degenerative or traumatic damaged collagen tissues by injecting/applying autologous blood concentrate, rich in growth factors and other biologically active molecules. PRP demonstrates huge potential in stimulating cell proliferation and metabolic activity in vitro. Trials with animals show/prove the full recovery of the structural changes and the matrix integrity of the damaged tissue. In recent years some prospective clinical studies and published case series report that PRP could be a safe and efficient therapy for patients with chronic low back pain that do not yield to traditional/standard treatment options. Data though limited/scarce for the time being includes/covers the most common cause for this complaint, namely pathology of the intervertebral discs, facet and sacroiliac joints, as well as paraspinal soft tissues. The possibility for precise intralesional application of this regeneration autologous product in the damaged tissue gives it a huge advantage over the common algorithms currently used in the clinical practice to treat patients with such complaints. Future bigger studies including image methods to evaluate the structural recovery of the degenerative changed tissue responsible/blamed for the pain and functional deficit would bring light to the place PRP therapy should take in the treatment of low back pain.