Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain

Fernando Kirchner, Eduardo Anitua, Fernando Kirchner, Eduardo Anitua

Abstract

Context: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge.

Aims: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain.

Settings and design: The study was designed as an observational retrospective pilot study. Eighty-six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012.

Subjects and methods: One intradiscal, one intra-articular facet, and one transforaminal epidural injection of PRGF-Endoret under fluoroscopic guidance-control were carried out in 86 patients with chronic LBP in the operating theater setting.

Statistical analysis used: Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow-up time points on pain reduction after treatment.

Results: Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF-Endoret injections showed a statistically significant drop from 8.4 ± 1.1 before the treatment to 4 ± 2.6, 1.7 ± 2.3, and 0.8 ± 1.7 at 1, 3, and 6 months after the treatment, respectively, with respect to all the time evaluations (P < 0.0001) except for the pain reduction between the 3rd and 6th month whose signification was lower (P < 0.05). The analysis of the VAS over time showed that at the end point of the study (6 months), 91% of patients showed an excellent score, 8.1% showed a moderate improvement, and 1.2% were in the inefficient score.

Conclusions: Fluoroscopy-guided infiltrations of intervertebral discs and facet joints with PRGF in patients with chronic LBP resulted in significant pain reduction assessed by VAS.

Keywords: Chronic low back pain; fibrin matrix; plasma rich in growth factors; platelet-rich plasma; visual analog scale.

Figures

Figure 1
Figure 1
PRGF preparation and infiltration of disc and lumbar facet joint. (a) Illustrative representation of PRGF obtaining process. Before the percutaneous infiltration, the fraction 2 of PRGF was activated with PRGF activator. (b) Illustration and fluoroscopic-guided lumbar intervertebral disc (insert 1 and 2) images and peridural infiltration (insert 3). (c) Drawing and fluoroscopic-guided lumbar facet joint infiltrations of PRGF showing an intradiscal (insert 1) and intra-articular (insert 2) position of the needle tip
Figure 2
Figure 2
Graphic representation of the postprocedural pain reduction assessed by visual analog scale showing a statistically significant pain reduction from basal visual analog scale to first, third, and sixth months after the treatment, respectively, with respect to all the time evaluation (**P < 0.0001) except for the visual analog scale between the 3rd and 6th month whose signification was lower (*P < 0.05)
Figure 3
Figure 3
Analysis of the visual analog scale. At the end point of study (after 6 months), 90.7% of patients revealed an excellent score (visual analog scale 0–3), 8.1% had a moderate score (visual analog scale 3.1–6.5), and 1.2% of patients showed an ineffective score (visual analog scale 6.6–10)

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