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Platelet-rich plasma in the management of chronic low back pain: a critical review

Authors Akeda K, Yamada J, Linn ET, Sudo A, Masuda K

Received 1 October 2018

Accepted for publication 21 January 2019

Published 25 February 2019 Volume 2019:12 Pages 753—767


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Erica Wegrzyn

Koji Akeda,1 Junichi Yamada,1 Erikka T Linn,2 Akihiro Sudo,1 Koichi Masuda2

1Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie 514-8507, Japan; 2Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA 92093-0863, USA

Abstract: Low back pain (LBP) is now regarded as the first cause of disability worldwide and should be a priority for future research on prevention and therapy. Intervertebral disc (IVD) degeneration is an important pathogenesis of LBP. Platelet-rich plasma (PRP) is an autologous blood concentrate that contains a natural concentration of autologous growth factors and cytokines and is currently widely used in the clinical setting for tissue regeneration and repair. PRP has great potential to stimulate cell proliferation and metabolic activity of IVD cells in vitro. Several animal studies have shown that the injection of PRP into degenerated IVDs is effective in restoring structural changes (IVD height) and improving the matrix integrity of degenerated IVDs as evaluated by magnetic resonance imaging (MRI) and histology. The results of this basic research have shown the great possibility that PRP has significant biological effects for tissue repair to counteract IVD degeneration. Clinical studies for evaluating the effects of the injection of PRP into degenerated IVDs for patients with discogenic LBP have been reviewed. Although there was only one double-blind randomized controlled trial, all the studies reported that PRP was safe and effective in reducing back pain. While the clinical evidence of tissue repair of IVDs by PRP treatment is currently lacking, there is a great possibility that the application of PRP has the potential to lead to a feasible intradiscal therapy for the treatment of degenerative disc diseases. Further large-scale studies may be required to confirm the clinical evidence of PRP for the treatment of discogenic LBP.

Keywords: intervertebral disc, intervertebral disc degeneration, platelet-rich plasma, PRP, low back pain

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