PRP and disc

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epidural man

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Has anyone tried PRP in the disc?

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My partner tried it (cash pay) and the pt was miserable for a month and did not receive any added benefit...I think PRP (or stem cells) mixed with fibrinogen in conjunction with biacculoplasty or IDET sounds intriguing.
 
Local guy in CO does PRP mixed with dexamethasone for cash $. Adding something new that doesnt work to something old that doesnt work. Genius.
 
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My partner tried it (cash pay) and the pt was miserable for a month and did not receive any added benefit...I think PRP (or stem cells) mixed with fibrinogen in conjunction with biacculoplasty or IDET sounds intriguing.



there is some animal studies using PRP with a matrix that kept the PRP their over time. That seemed to make a difference
 
Local guy in CO does PRP mixed with dexamethasone for cash $. Adding something new that doesnt work to something old that doesnt work. Genius.

I seem to recall Tenesma talking about one of his fellowship attendings who did intra-discal cortisone injections and the endless volume of calls from those patients (they didn't do well)
 
How old is the patient? What does the disk look like? If the disc and pt are old, PRP shouldn't work, just like it won't work much in an old, dry knee joint. The increased pain was because the PRP was too "red".....had too much blood which caused increased inflammation and pain. I'd try pure PRP(amber color) and stem cells. But the morphology of the disk is important.
 
How old is the patient? What does the disk look like? If the disc and pt are old, PRP shouldn't work, just like it won't work much in an old, dry knee joint. The increased pain was because the PRP was too "red".....had too much blood which caused increased inflammation and pain. I'd try pure PRP(amber color) and stem cells. But the morphology of the disk is important.

Too much rum Todd, too much rum.
 
I did it on one patient, 25 year old dancer otherwise pristine physical condition with a really nasty almost discitis looking L3/L4 disc. Was not discitis. PRP injection was uneventful and she was pain free 6 months later, but had also enrolled in a CBT programwhich may have done it, i dont know. Sure as hell was not going to fuse her, mbbs negative, etc.
 
Local guy in CO does PRP mixed with dexamethasone for cash $. Adding something new that doesnt work to something old that doesnt work. Genius.

haha i love it.
 
Im giving a talk on emerging treatments for low back pain tomorrow and thought Id include a scetion on regernerative medicine. Did a pubmed and google search and couldnt come up with any published trials of PRP or stem cell injection into human discs. Lots of rabbits and bench research.

Does anyone have any studies they can share? PDF would be greatly appreciated.
 
Im giving a talk on emerging treatments for low back pain tomorrow and thought Id include a scetion on regernerative medicine. Did a pubmed and google search and couldnt come up with any published trials of PRP or stem cell injection into human discs. Lots of rabbits and bench research.

Does anyone have any studies they can share? PDF would be greatly appreciated.

Attached is an article that may be of interest to you. Hope it helps.
 

Attachments

  • PRP EBM Evidence Based Medicine 2011.pdf
    249 KB · Views: 88
Thank you. That is a great review for my personal library. I didnt see a study in the tables that cited treatment for disc disease.

Any other clinical studies out there for PRP and disc?
 
Im giving a talk on emerging treatments for low back pain tomorrow and thought Id include a scetion on regernerative medicine. Did a pubmed and google search and couldnt come up with any published trials of PRP or stem cell injection into human discs. Lots of rabbits and bench research.

Does anyone have any studies they can share? PDF would be greatly appreciated.

Here's a case series of 2 patients who had stem cells implanted into their discs. I did a grand rounds yesterday on Regenerative Therapies in Pain Medicine.:thumbup:
 

Attachments

  • Yoshikawa 10 stem cells.pdf
    740.8 KB · Views: 95
Greg lutz (pmr from New York) current investigating intradiscal prp. He presented prelim data last April at aaom conference and, I think, at ISIS in Las Vegas. Not sure when all the data will be available.
 
Uh oh......Steve's world is about to explode. ;-)
 
Uh oh......Steve's world is about to explode. ;-)

equivalent literature at best. My n=1 for ACL partial tear and home made PRP is 100% relief at 6 weeks.

I'm at 75% better in n=10 for tennis elbow.

But the data is a bunch of mixed algorithms with inconsistent outcome measures for varying pathologies. It does not support PRP use, and especially given the financial incentive for cash pay, for buying expensive equipment, etc- I just cannot recommend it to my patients as part of a standard of care. Neither could Borg-Stein.

If they want it in an extraspinal location that I am comfortable with, I bill it as a tendon injection/trigger point.
 
Stem cell-based approaches for intervertebral disc regeneration.
Huang S, Tam V, Cheung KM, Long D, Lv M, Wang T, Zhou G.
Curr Stem Cell Res Ther. 2011 Dec;6(4):317-26.

Degeneration of the intervertebral disc is an age-related progressive process considered to be the major cause of a series of spine disorders, such as low-back pain that affects the majority of adult population and causes a huge loss of time from work and medical expenses. Numerous regenerative approaches are being developed with the aim to halt or reverse degeneration, including intradiscal administration of nucleus pulposus cells and mesenchymal stem cells and anabolic growth factors. Each of the currently proposed approaches, however, has exhibited certain limitations or shortcomings, largely due to our limited understanding on the cell biology, turnover mechanisms of the intervertebral disc as well as the etiology of disc degeneration. Intervertebral disc, particularly the central nucleus pulposus, is the largest enclosed and avascular tissue in the body and owes a microenvironment under high mechanical and osmotic pressures, at severely hypoxia, and with very limited nutrient supply. In order to achieve an optimal outcome of new regenerative therapies in such a harsh circumstance, identifying and characterizing endogenous regenerative properties of normal and degenerate intervertebral disc, including stem/progenitor cells themselves and extracellular factors located within the stem cell niche, may provide effective insights into selecting the most suitable cell sources and improving or rebuilding the microenvironment favorable for endogenous or transplanted stem cells.
 
Intervertebral disc regeneration or repair with biomaterials and stem cell therapy--feasible or fiction?
Chan SC, Gantenbein-Ritter B.
Swiss Med Wkly. 2012 May 31

The "gold standard" for treatment of intervertebral disc herniations and degenerated discs is still spinal fusion, corresponding to the saying "no disc - no pain". Mechanical prostheses, which are currently implanted, do only have medium outcome success and have relatively high re-operation rates. Here, we discuss some of the biological intervertebral disc replacement approaches, which can be subdivided into at least two classes in accordance to the two different tissue types, the nucleus pulposus (NP) and the annulus fibrosus (AF). On the side of NP replacement hydrogels have been extensively tested in vitro and in vivo. However, these gels are usually a trade-off between cell biocompatibility and load-bearing capacity, hydrogels which fulfill both are still lacking. On the side of AF repair much less is known and the question of the anchoring of implants is still to be addressed. New hope for cell therapy comes from developmental biology investigations on the existence of intervertebral disc progenitor cells, which would be an ideal cell source for cell therapy. Also notochordal cells (remnants of the embryonic notochord) have been recently pushed back into focus since these cells have regenerative potential and can activate disc cells. Growth factor treatment and molecular therapies could be less problematic. The biological solutions for NP and AF replacement are still more fiction than fact. However, tissue engineering just scratched the tip of the iceberg, more satisfying solutions are yet to be added to the biomedical pipeline.
 
Here's a case series of 2 patients who had stem cells implanted into their discs. I did a grand rounds yesterday on Regenerative Therapies in Pain Medicine.:thumbup:

Thank you. I mentioned in the talk
 
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