Abstract
Current studies evaluating the outcomes of intradiscal platelet-rich plasma (PRP) injections in degenerative disc disease (DDD) are limited. The purpose of this review was to determine if an intradiscal injection of PRP for degenerative discs results in a statistically significant improvement in clinical outcomes. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Level I-IV investigations of intradiscal PRP injections in DDD were sought in multiple databases. The Modified Coleman Methodology Score (MCMS) was used to analyze the methodological quality of the study. Only the outcome measurements used by more than 50% of the studies were included in the data analysis. The study heterogeneity and nature of evidence (mostly retrospective, non-comparative) precluded meta-analysis. Pre and post-injection pain visual analog scales (VAS) were compared using two sample Z-tests. Five articles (90 subjects, mean age 43.6 ± 7.7 years, mean follow-up 8.0 ± 3.6 months) were analyzed. Four articles were level IV evidence and one article was level II. Mean MCMS was 56.0 ± 10.3. There were 43 males and 37 females (10 unidentified). Pain VAS significantly improved following lumbar intradiscal PRP injection (69.7 mm to 43.3 mm; p<0.01). Two patients (2.2%) experienced lower extremity paresthesia after treatment. One patient (1.1%) underwent re-injection. No other complications were reported. In conclusion, intradiscal injection of PRP for degenerative discs resulted in statistically significant improvement in VAS with low re-injection and complication rates in this systematic review. It is unclear whether the improvements were clinically significant given the available evidence. The low level of evidence available (level IV) does not allow for valid conclusions regarding efficacy; however, the positive results suggest that further higher-quality studies might be of value.
Highlights
BackgroundLow back pain (LBP) is one of the most common causes of disability in the United States, with over 80% of American adults experiencing one or more lifetime episodes [1,2]
platelet-rich plasma (PRP) is an autologous concentrate of various cells and growth factors acquired from centrifuged whole blood with growing evidence of its application in the healing response across different specialties, in orthopedics
Eligible studies consisted of level I-IV (via Oxford Centre for Evidence-Based Medicine (CEBM)) therapeutic studies that investigated the outcomes of intradiscal PRP injections for lumbar degenerative disc disease (DDD) among adult human patients [23]
Summary
BackgroundLow back pain (LBP) is one of the most common causes of disability in the United States, with over 80% of American adults experiencing one or more lifetime episodes [1,2]. PRP has demonstrated to have an anti-inflammatory effect by decreasing pro-inflammatory mediators at the injected site primarily by reducing the transactivation of the inflammatory regulator, nuclear factor-kappa B, and by inhibiting the inflammatory enzymes cyclooxygenase 2 and 4, metalloproteinases, and disintegrins [19,20,21].
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