Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease

Mohamed Hussein, Tamer Hussein, Mohamed Hussein, Tamer Hussein

Abstract

Background: Lumbar multifidus muscle dysfunction and chronic low back pain are strongly correlated. There is no consensus regarding treatment of chronic LBP. The effect of platelet leukocyte rich plasma (PLRP) injections on atrophied lumbar multifidus (LMF) muscle and chronic low back pain has never been studied before.

Patients and methods: One hundred fifteen patients with chronic non-specific LBP fulfilled the inclusion criteria. Patients were treated with weekly PLRP injections for six weeks and followed up for 24 months. Primary outcome measures included Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI). Secondary outcome measures included Patient Satisfaction Index (PSI), modified MacNab criteria, and lumbar MRI at 12 months follow-up.

Results: One hundred and four patients completed the trial. There were no serious complications. NRS significantly improved gradually from a mean of 8.8 ± 8 pre-injection to 3.45 ± 2.9 by 12 months and ODI significantly improved gradually from a mean of 36.7 ± 3.9 to 14.6 ± 12.8 by 12 months (P < 0.005). After reaching maximum improvement between 12 and 18 months, all outcome measures remained stable till the end of the 24 months follow-up period with statistically insignificant changes (P > 0.05). 87.8% (65/74) of the satisfied patients showed increased cross-sectional area and decreased fatty degeneration of LMF muscle on MRI at 12 months follow-up.

Conclusion: PLRP injections into atrophied lumbar multifidus muscle represent a safe, effective method for relieving chronic low back pain and disability with long-term patient satisfaction and success rate of 71.2%. We recommend the use of the lumbar PLRP injections of LMF muscle to refine the inclusion criteria of lumbar fusion to avoid failed back syndrome.

Keywords: Atrophied lumbar multifidus muscle; Chronic low back pain; PLRP; Paraspinal muscles.

Figures

Figure 1.
Figure 1.
MRI lumbar spine; (a) sagittal view shows L3-4 disc degeneration, (b) axial view of the same patient shows atrophied multifidus on the same level of L3-4 disc degeneration, (c) increased cross-sectional area of LMF after 12 months of local intramuscular PLRP injection.
Figure 1.
Figure 1.
MRI lumbar spine; (a) sagittal view shows L3-4 disc degeneration, (b) axial view of the same patient shows atrophied multifidus on the same level of L3-4 disc degeneration, (c) increased cross-sectional area of LMF after 12 months of local intramuscular PLRP injection.
Figure 2.
Figure 2.
During the first 12 months of the follow-up period the percentage of patients with (excellent) and (good) outcome increased reaching maximum at 12 months follow-up, whereas the percentage of patients with (fair) and (poor) outcome decreased and then remained stable until the end of follow-up.
Figure 2.
Figure 2.
During the first 12 months of the follow-up period the percentage of patients with (excellent) and (good) outcome increased reaching maximum at 12 months follow-up, whereas the percentage of patients with (fair) and (poor) outcome decreased and then remained stable until the end of follow-up.
Figure 3.
Figure 3.
(a) Axial view of lumbar spine MRI shows severe multifidus atrophy, fatty degeneration (high signal intensity) is nearly 50% (red circle), (b) axial view of the same patient after one year post-injection of PLRP into atrophied lumbar multifidus with decreased fatty degeneration.
Figure 3.
Figure 3.
(a) Axial view of lumbar spine MRI shows severe multifidus atrophy, fatty degeneration (high signal intensity) is nearly 50% (red circle), (b) axial view of the same patient after one year post-injection of PLRP into atrophied lumbar multifidus with decreased fatty degeneration.
Figure 4.
Figure 4.
(a) Axial view of lumbar spine MRI shows severe multifidus atrophy, fatty degeneration (high signal intensity) is more than 50% (red circle), (b) axial view of the same patient after 15 months post-injection of PLRP into atrophied lumbar multifidus with decreased fatty degeneration.
Figure 4.
Figure 4.
(a) Axial view of lumbar spine MRI shows severe multifidus atrophy, fatty degeneration (high signal intensity) is more than 50% (red circle), (b) axial view of the same patient after 15 months post-injection of PLRP into atrophied lumbar multifidus with decreased fatty degeneration.

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Source: PubMed

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