84% of Americans experience back problems at least once or more times during their lifetime. 8% of the population 18 and older have chronic back pain limiting their work and activities.
The CDC reports 39% of adults experienced back pain, 36.5% experienced lower limb pain and 30.7% experienced upper limb pain. The prevalence of pain in these areas increases with age and was the highest among adults 65 years of age and older.
The biggest cause of back pain is an injury like a strained or pulled muscle. Medical conditions such as arthritis, disc problems, sciatica or inflammatory diseases are also common causes of low back pain. Back pain can also be referred from a more serious condition such as cancer or an infection.
Red flags for back pain are pain lasting greater than 6 weeks, pain in younger than 18 and older than 50, pain that radiates below the knee, history of major trauma, pain that is unrelenting especially at night, constitutional symptoms and acute muscle weakness are a few of the symptoms that should be addressed immediately.
Treatments for low back and spinal abnormalities are numerous and varied. Conservative treatments such as medication and rehabilitation have a certain degree of effectiveness. However, when conservative treatments, fail or are less effective, surgical intervention is often recommended. In the surgical setting, spinal fusion is often indicated in cases of high instability or degeneration. Spinal fusion is often accompanied with bone grafting. However, bone grafting fails to fuse in an estimated 25 to 35% of the cases causing a pseudoarthrosis. Biological and cellular therapies are now utilized in a variety of these surgical cases.
Biologics and cellular therapies are being utilized in a wide variety of low back and spinal treatment. Platelet Rich Plasma is being used clinically due to the regenerative capabilities of this concentrate. PRP has been shown to repair damaged tissues such as tendon, cartilage and bone and recently as an adjunctive treatment in a multitude of spinal diseases and treatments.
Mechanism of Action
Upon activation of platelets, platelets release several types of inclusions. These contain alpha granules and lysosomes. The alpha granules are the most abundant and they contain membrane bound proteins. Membrane bound proteins are expressed on the cell surface while soluble proteins are released into the extracellular compartment. The alpha granules also contain exosomes which are released following activation. There are 300 proteins currently identified during this process. These proteins have diverse roles in hemostasis, inflammation, host defense, angiogenesis and overall wound healing.
The exosomes contain messenger RNA and play an essential function in coagulation, inflammation and tissue repair.
In theory, Platelet Rich Plasma with a supra-physiologic concentration of these bioactive proteins and exosomes have the potential to repair damaged tissue and stimulate regenerative repair and regeneration. PRP is being utilized worldwide in spinal treatments and surgery.
Three Critical Steps in Platelet Rich Plasma Use
Platelet Rich Plasma has 3 critical areas where the overall processing can affect the outcome when used for spinal applications or any other area for tissue regeneration.
- Platelet concentration ratio from less than 2-fold to 8.5 -fold has been reported,however the literature suggests a 3 to 5 fold increase is desirable. A certain concentration of platelets is necessary because a low concentration tends to reduce the number of growth factors. On the converse, a high concentration can cause significant tissue damage.
- The activation of platelets is critical. This process causes degranulation and growth factors are released. Activated PRP has been shown to be more effective than non-activated.
- The number of leukocytes contained in the PRP is critical. If the number of leukocytes is
- high than there can be too much inflammation. If the leukocytes are absent, there can be a poor response to the treatment as leukocytes are necessary to fight infection and signal cytokines and other growth factors needed for the overall reparative process.
Platelet Rich Plasma for Disc Disease
The use of PRP for disc disease was first reported in 2006. Many human and animal studies have been done on this topic. Recently, it was found the growth factors contained in PRP act as a “growth factor cocktail” to promote proliferation and differentiation of the nucleus pulposus cells. In addition, exosomes derived from PRP were reported to alleviate intervertebral disc degeneration associated inflammation by regulating the autophagic degradation of inflammasomes.
In 2017, a study published demonstrated injected intravertebral discs in animals led to histologic improvement in the degenerative process proven by MRI. The authors concluded that PRP has a great potential for clinical application against disc degeneration and to promote disc regeneration.
PRP was used intradiscally and patients had a follow up period of 3 months to 6.57 years. Participants who received intradiscal PRP showed significantly greater improvements in functional rating and satisfaction scores.
A clinical trial between corticosteroids and PRP showed clinically significant improvement between both groups initially but the PRP group maintained improvements in low back pain and disability scores during a 60 week follow up.
A recent study retrospectively evaluated the effect of transforaminal endoscopic lumbar discectomy with PRP for patients with disc herniation. They reported TELD with PRP treatment significantly improved low back pain and low back pain disability, MRI findings, and lowered the
recurrence rate compared to those who did not receive the PRP. They concluded intradiscal PRP for degenerative disc disease is safe and shows promise for improving pain and disability.
PRP for Spinal Fusion
Clinical application of PRP for spinal fusion was first reported in 2003. Since that time, 17 clinical studies have been conducted.
A randomized controlled study with a 2 year follow up to evaluate the efficacy of PRP after fusion surgery was conducted. 61 patients were divided into 31 receiving PRP and 31 did not. All patients underwent surgery for degenerative lumbar spondylosis with instability. This clinical study demonstrated the bone fusion rate at the final follow up was significantly higher (94%) in the PRP group than control (74%). The fusion mass was greater in the PRP group and the period necessary for the fusion was shorter in the PRP group.
Another study reported the efficacy of PRP in fusion surgery in a follow up of 10 years post-surgery. The PRP group had earlier fusion and there were no reported adverse symptoms or visible infections on MRI over the 10 year follow up.
Platelet Rich Plasma for Intraarticular Therapy of Facets or Sacroiliac Joint Pathology
PRP for facet pathology was first reported in 2016.
Recent studies have shown when PRP was compared to corticosteroids/lidocaine both were efficacious in the treatment of facet problems. Both were safe, effective and easy to use under fluoroscopic x-ray guidance. However, autologous PRP had better outcomes in the 3 to 6 month follow up period.
In 7 studies concerning the use of PRP injected into the SI joint and followed for a period of 3 months to 4 years, the reduction in pain intensity and improvements in functional disability were significantly greater and lasted longer in the PRP group compared to the steroid treated group.
The summary in these studies concluded injection therapy of PRP for patients with facet joint or sacroiliac joint pain is safe and useful for improving pain, disability and quality of life.
Platelet Rich Plasma for Epidural Therapy
In patients who had low back pain, lasting greater then 3 months, with or without radiculopathy, were treated with epidural cortisone or PRP. All injections were done under fluoroscopic guidance and placed into the epidural space. At the one-month period post injection, both steroid and PRP groups showed significant improvement. However, the PRP group showed sustained improvements at the six-month interval over the steroid treated group. The authors concluded that both autologous PRP and corticosteroids for caudal epidural injections are equally safe and therapeutically effective in patients with chronic low back pain and that PRP is superior to corticosteroids for achieving an increased duration of the analgesic effect and improved quality of life.
In the review of the most recent literature concerning the use of Platelet Rich Plasma in the treatment of a multitude of spinal diseases, PRP is a safe and effective option over corticosteroids with longer lasting benefits and improved quality of life.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. They are cost effective and easy to use. Our kits have been scientifically manufactured to provide a consistent platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative proves. The activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.
Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products”, has different growth factors and cytokines than the original PRP. These different cytokines provide a broader range of clinical uses due to their anti-inflammatory properties.
Juventix Regenerative Medical also offers many other products, devices and services for all the needs of the regenerative practitioner. The devices and products are all FDA cleared or approved making Juventix a “one stop shop” for all regenerative supplies, while saving time and money.
RESTORE, REVIVE, REGENERATE-JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
Studies
Japanese Orthopedic Association Clinical Practice Guidelines on the Management of Spinal Stenosis
J Orthop Sci 2023 Jan;28(1):46-91 PMID 35597732
Platelet Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020
Int J Mol Sci 2020 Oct 21;21(20):7794 PMID 33096812
Platelet Rich Plasma in the Management of Chronic Low Back Pain: Review
J Pain Res 2019 Feb 25;12:753-767 PMID 30881089
Advances in Platelet Rich Plasma Treatment for Spinal Diseases: Review
Int J Mol Sci 2023 Apr 21;24(8):7677 PMID 37108837
