Intradiscal Platelet Rich Plasma
Condition: Discogenic Pain; Low Back Pain; Chronic Pain
MeSH terms: Back Pain; Low Back Pain; Chronic Pain
Intervention: Low back intradiscal injection of platelet rich plasma (PRP)
Intervention description: SOC Intradiscal Lumbar PRP Procedure : A small amount of blood is drawn from you, then it is spun in a centrifuge to obtain only the platelets and few other cells. After being spun the small amount of platelets will be injected into the specific disc that is believed to be causing pain in an attempt to help reduce inflammation and pain at the site. The injection will be done under fluoroscopic guidance (x-ray) that allows very careful and precise placement of the needle.
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 3.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Platelet Rich Plasma

Summary:

      To assess changes in pain and function in patients with discogenic low back pain after a
      standard of care intradiscal injection of Platelet-Rich Plasma (PRP).
    

Eligibility criteria:

        Inclusion Criteria:

          1. Age greater than 18 years of age at day of enrollment.

          2. Clinical diagnosis of refractory discogenic low back pain for >3 months.

          3. Magnetic resonance imaging pathology consistent with clinical symptoms/signs or
             positive lumbar provocative discography according to SIS/IASP standards at one or two
             levels.

          4. Back pain greater than leg pain with an intensity of at least 4/10 or higher using the
             Numerical Rating Scale (NRS).

          5. Pain duration of more than 12 weeks despite trial of conservative therapy
             (medications, physical therapy, or chiropractic care) for 2 months.

        Exclusion Criteria:

          1. Refusal to participate, provide consent, or provide follow-up information for the
             24-month duration of the study.

          2. Contraindications to intradiscal injection of PRP (active infection, bleeding
             disorders, current anticoagulant or antiplatelet medication use, allergy to iodinated
             contrast, penicillin or clindamycin and pregnancy or breastfeeding).

          3. More than 2 levels of clinical or discogram proven pain.

          4. Non-discogenic source of low back pain as identified by separate diagnostic blocks.

          5. Negative lumbar provocation discography.

          6. Active moderate to severe lumbar radiculopathy.

          7. Intradural disc herniation.

          8. Spinal fracture within the past 6 months.

          9. Steroid injection in the spine within the last 30 days.

         10. Any intradiscal injection other than contrast dye or anesthetic in the last 30 days.

         11. Prior fusion at level considered to be the source of the pain.

         12. Prior lumbar spine surgery within the last 6 months.

         13. AP diameter of spinal canal less than or equal to 9mm at level to be treated.

         14. Severe uncontrolled medical condition.

         15. Moderate to severe hepatic dysfunction.

         16. Severe psychological illness.

         17. History of Inflammatory arthritis.

         18. Malignancy within past 5 years except basal cell or squamous cell skin cancer.

         19. Current use of equal to greater than 30mg morphine-equivalent per day of opioid use.

         20. A history of alcohol or drug abuse within past 5 years.

         21. Use of any investigational drug within past 30 days.

         22. A known allergy or sensitivity to citrate (used for processing PRP).

         23. Severe anaphylactic/anaphylactoid reaction to any medications used.

         24. Pending litigation involving subject's back pain.

         25. No insurance coverage for any subsequent tests or procedures.

         26. Disc protrusion greater than 5mm from base of vertebral body.

         27. Greater than 50% disc height loss at involved level(s).

         28. Inability or unwillingness to continue rehabilitation protocols.