Regenerative Injection Treatment in the Spine: Review and Case Series with Platelet Rich Plasma

Background: Platelet-Rich Plasma (PRP) has been used for a variety of musculoskeletal disorders including tendinopathies and Osteoarthritis. Few studies exist for PRP in the spine, except for studies involving disc pathology. However, numerous studies exist involving the use of Prolotherapy for spinal disorders. Both Prolotherapy and PRP can be considered within the broad category of Regenerative Injection Treatment (RIT), which are proposed to strengthen or repair injured ligaments, tendons, muscle, cartilage, and bone via injections of proliferative solutions, growth factors, or cells. Provided that double blind randomized controlled trials have shownboth PRP and Prolotherapy to be effective in treating similar regions of the body, it is reasonable to consider that PRP could be comparatively effective as Prolotherapy in treating pain related to the facet joints, capsules and associated spinal ligaments. Objective: Our aim is to provide an overview of Prolotherapy and PRP applications in the spine and present a 5 patient case series of PRP injections involving the lumbar, thoracic, and cervical spine. Study design: This study is a single center observational case series with 5 patients. Patients were selected on the basis of a strict diagnostic criteria and inclusion factors. Each patient received a series of 3 PRP injections into the affected facet joints and surrounding ligaments using fluoroscopic or ultrasound guidance. Relative immobilization with bracing was prescribed for 72 hours following the injections. Follow up examinations ranged from 6-12 months. Setting: Procedures were performed in an outpatient setting in Los Angeles, California. Results: Case 1: 60% symptom improvement following 2nd injections, 100%improvement & return to sport at 6 months; Case 2: at least 30% symptom improvement following 1st injection, 60% improvement following the 2nd series, &1/10 VAS scale at 9 months; Case 3: at least 40% symptom improvement following 2nd injections, 2/10 VAS scale and improvement in functional status at 12 months; Case 4: 70% symptom improvement & increased functional status following 3rd injections; Case 5: 65-70% symptom improvement and increased functional status at 6-month follow-up. Patient reported reduced fear and anxiety over inciting events, improved sleep, and decreased pain medication use. Limitations: The self-reported VAS pain scale and functional scores could be a source of bias and potentially decrease the validity of the results. However, the cost effectiveness and subjectivity of such measurements make it an easy to use method for measuring therapeutic efficacy through patient satisfaction, regardless of objective measures. The small sample size is also a limitation, and larger patient sizes in future studies are needed to further evaluate the treatment’s effectiveness. In addition, the follow up time ranged from 6-12 months. To better assess the long term effects of such treatment, patient follow up at 18 and 24 months would provide better long term data. Conclusions: Platelet Rich Plasma injections can potentially represent a viable treatment option for spinal pain related to facet joints, capsules, and spinal ligaments. Further investigation with larger patient numbers and longer follow up periods are needed. have focused on tendon injuries [2] including patellar tendinosis (jumper’s knee) [3], lateral epicondylosis (tennis elbow) [4] and Achilles tears/tendinopathy [5]. More recently, high quality studies including randomized controlled trials have emerged using PRP