David Levi1, Scott Horn2, Sara Tyszko2, Josh Levin3, Charles Hecht-Leavitt4, Edward Walko2. 1. *APM Spine and Sports Physicians, Norfolk, Virginia levid@cox.net. 2. *APM Spine and Sports Physicians, Norfolk, Virginia. 3. Stanford School of Medicine, Department of Orthopaedic Surgery, Redwood City, California. 4. MRI and CT Diagnostics, Virginia Beach, Virginia, USA.
Abstract
BACKGROUND:Platelet-rich plasma (PRP) has been found to be effective for a variety of musculoskeletal conditions. The treatment of discogenic pain with PRP is under investigation. OBJECTIVE: To assess changes in pain and function in patients with discogenic low back pain after an intradiscal injection of PRP. STUDY DESIGN: Prospective trial. METHODS:Patients were diagnosed with discogenic low back pain by clinical means, imaging, and exclusion of other structures. Provocation discography was used in a minority of the patients. Patients underwent a single treatment of intradiscal injection of PRP at one or multiple levels. MAIN OUTCOME MEASURES: Patients were considered a categorical success if they achieved at least 50% improvement in the visual analog score and 30% decrease in the Oswestry Disability Index at 1, 2, and 6 months post-treatment. RESULTS:22 patients underwentintradiscal PRP. Nine patients underwent a single level injection, ten at 2 levels, two at 3 levels, and one at 5 levels. Categorical success rates were as follows: 1 month: 3/22 = 14% (95% CI 0% to 28%), 2 months: 7/22 = 32% (95% CI 12% to 51%), 6 months: 9/19 = 47% (95% CI 25% to 70%). CONCLUSION: This trial demonstrates encouraging preliminary 6 month findings, using strict categorical success criteria, for intradiscal PRP as a treatment for presumed discogenic low back pain. Randomized placebo controlled trials are needed to further evaluate the efficacy of this treatment.
RCT Entities:
BACKGROUND: Platelet-rich plasma (PRP) has been found to be effective for a variety of musculoskeletal conditions. The treatment of discogenic pain with PRP is under investigation. OBJECTIVE: To assess changes in pain and function in patients with discogenic low back pain after an intradiscal injection of PRP. STUDY DESIGN: Prospective trial. METHODS:Patients were diagnosed with discogenic low back pain by clinical means, imaging, and exclusion of other structures. Provocation discography was used in a minority of the patients. Patients underwent a single treatment of intradiscal injection of PRP at one or multiple levels. MAIN OUTCOME MEASURES: Patients were considered a categorical success if they achieved at least 50% improvement in the visual analog score and 30% decrease in the Oswestry Disability Index at 1, 2, and 6 months post-treatment. RESULTS: 22 patients underwent intradiscal PRP. Nine patients underwent a single level injection, ten at 2 levels, two at 3 levels, and one at 5 levels. Categorical success rates were as follows: 1 month: 3/22 = 14% (95% CI 0% to 28%), 2 months: 7/22 = 32% (95% CI 12% to 51%), 6 months: 9/19 = 47% (95% CI 25% to 70%). CONCLUSION: This trial demonstrates encouraging preliminary 6 month findings, using strict categorical success criteria, for intradiscal PRP as a treatment for presumed discogenic low back pain. Randomized placebo controlled trials are needed to further evaluate the efficacy of this treatment.
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