Intradiscal

PRP

By Dr. Craig Best

What is discogenic low back pain?

Lumbar intervertebral discs are a common cause of chronic low back pain. A fissure or tear in the outer fibrous portion of the disc, the annulus fibrosus, can allow some of the inner liquid portion, the nucleus pulposus, the leak out. This can lead to a chronic inflammatory response, ingrowth of nerves around the fissure, and increased sensitization of the disc. The gold standard method for diagnosis of discogenic low back pain is via provocative discography.

What is platelet-rich plasma (PRP)?

Platelet-rich plasma is component of the patient’s own blood. It is rich in growth factors and can also signal an increased healing response to a damaged tissue. It is used to treat a variety of painful musculoskeletal conditions.

 

How does intradiscal PRP work?

After the painful disc(s) is/are identified via provocative discography, the PRP solution can then be injected back into the problematic disc(s) using x-ray (fluoroscopic) guidance. The PRP solution then stimulates the body’s healing response. As the disc heals, the patient’s pain and overall function improve.

Am I a candidate for intradiscal PRP injection?

Intradiscal PRP injection is typically reserved for patients who have chronic low back pain that has failed to respond to conservative treatment options such as medications, physical therapy, chiropractic, and epidural steroid injections, and for whom surgery is the only other option. Additionally, discogenic low back pain must be proven via provocative discography to ensure the proper pain generating spinal structure is precisely identified.

What are the results of intradiscal PRP?

There are now multiple studies demonstrating that, in properly identified patients, intradiscal PRP injections can provide improvements in pain and function. Patient satisfaction scores are consistently favorable in those who have undergone intradiscal PRP.

Conclusion

If you’ve been suffering from chronic low back pain despite medications, physical therapy, chiropractic, and injections, and are hoping to avoid surgery, you may be a candidate for intradiscal PRP. For initial consultation and to discuss intradiscal PRP, please contact OSNI to book an appointment with Dr. Craig Best.

Dr. Best utilizes thorough history and physical examination, imaging, electrodiagnostic studies, and diagnostic injections to identify specific pain generators and provides comprehensive treatment plans that may consist of medications, detailed physical/occupational therapy or exercise prescriptions, osteopathic manual medicine, or injections. Dr. Best’s ultimate goal for his patients is to provide them with the tools to live a healthier, more functional life.

After graduating from Lincoln Memorial University’s DeBusk College of Osteopathic Medicine, Dr. Best completed his Physical Medicine & Rehabilitation (Physiatry) residency at Rush University Medical Center. He subsequently completed a fellowship in Interventional Pain Medicine at Beth Israel Deaconess Medical Center, a Harvard Medical School teaching hospital. He is board certified in Physical Medicine & Rehabilitation as well as the subspecialty of Pain Medicine.

However, as we all grow into adulthood we have less and less of these stems cells, therefore we have less and less ability to repair injuries and the aging process.

The excitement about stem cells rests in the belief that since they have the ability to form any kind of cells we could use them to repair any damaged cells in the body. For example, for patients with damage to the heart muscle, stems theoretically could be injected into the heart to repair the damage and allow the heart to function normally.

The same idea exists for any disease process such as brain disease, spinal cord injury and even arthritis in the knee, hip and shoulder.

Despite this, there are many concerns about stems cells. One of the main concerns is whether these cells could become tumors because of their ability to differentiate into any kinds of cells once reintroduced into the body. One possible solution to this problem is to have the stem cells differentiate to the desired cells type before they are used.

One main unknown about stem cells is how they are triggered to start growing into different cells and what ultimately stops them from growing. We do not know if that by simply injecting the cells into a damaged body part will cause them to grow and to perform repair. It is also not known if the cells need other substances within the body to help them grow and replace the damaged cells.

Currently, the use of stem cells is not FDA-approved for use within the United States in clinical practice unless in a research setting. Therefore, most stem cell treatments being currently advertised on TV or on the internet do not have official FDA sanction unless it being used in an approved research study.

And, even in those approved studies, the FDA has restricted how the stem cells can be used. The cells are approved to removed or harvested from the patient, purified and re-inserted in to the patient. The stems are not allowed to be expanded, that is being grown, before injected back into the patient.

These guidelines by the FDA make it difficult to perform clinical research in the U.S. on the amount of stem cells that will be needed for a given condition. Therefore, no one is certain that even if stems cells can treat a condition how many cells are needed.

Patients who want to use stems cells to treat a medical condition are best served by finding an accredited research project treating their conditions, since it is not always possible some patients who can afford the cost of stem cell treatment are travelling overseas to have their treatment done.

So although stem cells hold great future promise there are many current unknowns that will limit their application in treating diseases.

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