The spine is the central supporting structure of the torso and body. It protects the spinal cord and provides flexibility and shock absorption. Lumbar degenerative spine disease is a common cause of disability and lost time from work due to injury.
The measure of worldwide burden does not exist because of unreported incidence, especially in third world countries.
A meta-analysis estimated 266 million individuals have degenerative spinal disease or low back pain each year. The highest estimates were found in Europe at 5.7% and the lowest was Africa at 2.4%. This low estimate is probably due to under reporting.
Low and middle income countries have 4 times as many cases as high income countries.
The types of spinal degenerative pathologies include stenosis, spinal curvatures (Kyphosis, Lordosis, Scoliosis), diffuse idiopathic skeletal hyperostosis, spondylosis, osteoporosis and disc degeneration. With more than a third of the US population over 65 years old and high rates of obesity, experts project the rates to increase in the next 10 years.
Etiologies
Spinal Stenosis
Stenosis refers to the narrowing of the spinal canal applying pressure to the spinal cord. This can be either in the canal itself or the neural foramina where the nerves exit. Stenosis can be congenital, but the common etiology is degenerative in origin. The most prevalent symptom is numbness and tingling followed by pain.
Spinal Curvatures
Kyphosis, lordosis, and scoliosis are types of spinal curvatures. Kyphosis refers to a convex curve in the sagittal plane typically in the upper thoracic spine. Scoliosis is a curvature of the thoracic or lumbar spine in the coronal plane. Curvature to the left is a levoscoliosis or to the right is a dextroscoliosis. A Lordosis usually refers to excessive concave curvature of the lumbar spine in the sagittal plane.
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Diffuse idiopathic skeletal hyperostosis (DISH) is a disorder where excessive bone formation and ossification occur in the soft tissue structures along the anterior and lateral aspects of the spine. This occurs with preservation of intervertebral disc height and apophyseal joints. This is a form of ankylosing hyperostosis and can occur in lumbar or cervical regions but is more common in the thoracic spinal area.
Spondylitis
Spondylitis refers to inflammation of the joints of the spine. This can happen with acute injury or with chronic conditions such as systemic inflammatory diseases. One type of spondylitis is ankylosing spondylitis which can cause significant inflammation in the sacroiliac joints and spinal ligaments.
Spondylolisthesis is often confused with spondylitis. Spondylolisthesis refers to movement of one vertebral segment upon another.
Osteoporosis
Osteoporosis is the result of an imbalance between the rate of bone resorption and bone deposition. A decrease in bone mineral density of trabecular bone such as a vertebral body results in a reduction of stress and load tolerance and the bone can collapse.
Intervertebral Disc Degeneration
Degeneration of the intervertebral discs is a common finding in the spine. The pathological problems in this area include disc bulges, disc herniations, osteophytes, loss of disc height and disc desiccation. Osteophytes or bone spurs are found at the ends of the disc plates and develop in response to alterations in pressure.
The overwhelming majority of pathology in back pain is due to degeneration of discs. The incidence has increased because of the newer imaging techniques such as CT scanning and MRI.
Causes and Symptoms of Disc Degeneration
Although spinal discs wear down as a normal part of the aging process, especially over the age of 40, not all people experience pain.
The cause of this “wearing out” is due to the discs drying out. Discs are mostly water and dehydrate over time. As a result, the discs become thinner and don’t provide the shock absorption as they did in the past.
Small tears or fissures can appear and lead to herniation of the material inside the disc. This herniation of material often causes pressure on the spinal nerve roots and causes pain, numbness and tingling.
Over time, chronic compression on a nerve root not only causes pain and numbness but loss of muscle strength in the corresponding area innervated by the nerve. Muscle atrophy can result.
Management and Treatment
- Physical therapy to strengthen the muscle groups involved
- Medications such as NSAIDS, muscle relaxers, oral steroids
- Steroid injections near the nerve root compressed to reduce inflammation and pain
- Radiofrequency ablation to burn the nerves and prevent signals from reaching the brain
- Others include acupuncture, decompression, bracing, herbal supplementation etc.
Spinal Decompression Surgery
In Refractory cases, surgery may be contemplated for relief of persistent pain or weakness.
- Diskectomy- removing part of the disc abutting the nerve roots
- Foraminotomy- expanding the opening where the nerve roots exit the spinal canal by removing tissue or bone
- Laminectomy- which is removing a portion of the vertebrae
- Spinal Fusion- joining two or more vertebrae together for stability
Platelet Rich Plasma
Platelet Rich Plasma is an autologous blood concentrate that is rich in cytokines, growth factors and bioactive proteins. The high concentrations of these substances has led to a rise in the
popularity of PRP in all fields of medicine due to the regeneration of damaged tissues. Platelet Rich Plasma has been effective in reducing pain and related symptoms in the treatment of back pain. PRP has been used for pain in back related conditions including vertebrogenic and discogenic back pain. Recent studies have delved into the application of platelet rich plasma as a potential remedy for complex back ailments.
Clinical Trials and Effectiveness
Researchers conducted an initial clinical trial to assess the safety and initial effectiveness of intradiscal injection of autologous PRP for discogenic low back pain. Preliminary clinical trials have shown promising results with intradiscal injection of autologous platelet rich plasma. This approach involves injecting PRP directly into the intervertebral discs to promote tissue regeneration and repair. This treatment option has demonstrated safety, efficacy, and effectiveness, providing an alternative for patients with discogenic low back pain.
Managing Cervico-Discogenic Pain
Besides intradiscal injection, PRP has also been used to manage cervico-discogenic pain. In this study, ultrasound guided cervical intervertebral disc injection of PRP to alleviate pain in a patient with cervical disc pain. This technique involved injecting PRP mixed with lidocaine under ultrasound guidance. The use of PRP in this case resulted in pain relief and improved functional outcomes.
Antimicrobial Properties
In another recent study, researchers examined the safety of intradiscal platelet-rich plasma by reviewing its antimicrobial properties against Cutibacterium acnes, a bacterium commonly associated with intervertebral disc degeneration. This study found that PRP had antimicrobial effects against C.acne, suggesting that it may have a protective role in preventing infection following intradiscal injections.
Long-Term Effects
The use of PRP in the management of discogenic pain has also been supported by studies evaluating its long term effects. Akeda et al conducted a long term follow up survey and found that PRP therapy provided sustained pain relief in patients with discogenic low back pain. This study showed the effectiveness and improvement in pain without hindering daily life activities for up to five years after the treatment period.
Studies
Asian Spine 2017 Jun;11(3):380-389 PMID 28670405
Purpose: To determine the safety and initial efficacy of intradiscal injection of autologous platelet rich plasma in patients with discogenic low back pain.
Conclusion: We demonstrated that intradiscal injection of autologous PRP in patients with low back pain was safe with no adverse events during follow up.
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Optimizing the Safety of Intradiscal Platelet Rich plasma: An in Vitro Study with Cutibacteruim acnes
Regenerative Med 2019;14:955-67 doi.org/10.2217/rme-2019-0098
Aim: The most common risk associated with intradiscal injection of platelet rich plasma is discitis with Cutibacterium acnes.
Conclusion: We observed the greatest antimicrobial activity with the leukocyte rich, high platelet count PRP preparation combined with an antibiotic in the injectate. However, cefazolin alone did not completely clear the bacteria.
This report presents a novel ultrasound guided needle placement technique to the cervical intervertebral discs using a more medial approach between the trachea and thyroid gland and the carotid sheath. The discs were injected with platelet rich plasma and lidocaine.
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The Role of Platelet Rich Plasma in Vertebrogenic and Discogenic Pain: A Systematic Review and Meta-Analysis Curr Pain Headache Rep 2024 Jun 8 PMID 38850492. (ahead of print)
In recent decades, there has been a rise in popularity of the use of platelet rich plasma for treatment of numerous musculoskeletal conditions.
Related to high concentrations of platelets, growth factors, cytokines and chemokines, platelet rich plasma is effective in reducing pain related symptoms and in the treatment of back pain. Platelet Rich Plasma use has evolved and gained popularity for pain related conditions including vertebrogenic and discogenic back pain.
Researchers need to conduct additional well-designed studies in the future to better determine best practice strategies, providing clinicians with a solid foundation of evidence to advance regenerative medical therapies such as platelet-rich plasma.
Author’s note: Surgeons perform nearly 300,000 lumbar discectomy procedures annually in the US.
Platelet Rich Plasma seems to be an excellent treatment in patients with degenerative disc disease. Patients should discuss this noninvasive modality with their healthcare provider prior to invasive procedures.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our FDA-cleared Platelet Rich Plasma Kits are designed for safety, sterility, and effectiveness. We scientifically manufacture our kits to provide a platelet concentrate, free of red blood cells, with a minimal number of leukocytes critical to the regenerative process.
Juventix Regenerative Medical offers a LED Activator to activate the platelets and begin the regenerative process. Activating the platelets with LED light is a critical step in releasing cytokines, growth factors, and bioactive proteins from the alpha granules. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation guidelines of the FDA.
Juventix Regenerative Medical supplies a Bio-Incubator to transform the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory microenvironment and can be used confidently in inflammatory conditions.
Juventix Regenerative Medical has an array of services, devices and products for the regenerative professional. Juventix is ever striving to offer the best, cost effective products that are cleared, approved or registered by the FDA. Safety and efficacy are always primary goals for Juventix. When choosing regenerative therapies, consider Juventix.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
