Intradiscal Injection of Autologous Platelet-Rich-Plasma for the Treatment of Lumbar Disc Degeneration -Preliminary Prospective Clinical Trial for Discogenic Low Back Pain Patients-

INTRODUCTION: Intervertebral disc (IVD) degeneration is an important clinical problem that often contributes to low back pain and degenerative disc diseases. Degeneration of the IVD induces anulus tears and fissures, which can cause severe discogenic low back pain. Because the IVD has little potential to self-regenerate, treatment of degenerative disc disease is one of the most challenging clinical problems facing the spine surgeon. Platelet-rich plasma (PRP) is a fraction of plasma that contains platelets and multiple growth factors concentrated at high level. Because activated platelets have the potential to release growth factors including IGF-1, TGF-β, PDGF and EGF, PRP has been clinically used to accelerate wound healing and tissue regeneration in orthopedic and oral surgery [1]. The soluble releasate isolated from platelet-rich-plasma (PRP) has recently been demonstrated to influence the metabolism of intervertebral discs in vitro [2]. Furthermore, an intradiscal injection of autologous PRP has been shown to induce restoration of structural changes in the rabbit anular injection model in vivo [3]. Based on a preclinical study, we performed a preliminary clinical trial to determine the safety and efficacy of an intradiscal injection of autologous PRP-releasate in patients with discogenic low back pain. Furthermore, for safety in clinical use, we have isolated autologous PRP-releasate by activating PRP using autologous serum instead of bovine thrombin.