Epidural Plasma Rich in Growth Factors for Degenerative Disc Disease: A Valuable Alternative to Conventional “Palliative Medicine”
International Journal of Anesthesia and Clinical Medicine
Volume 7, Issue 1, June 2019, Pages: 1-6
Received: Aug. 19, 2018; Accepted: Oct. 23, 2018; Published: Feb. 28, 2019
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Correa Jose, Anesthesiologist and Pain Unit, Fundación Universitaria JN Corpas, Bogotá, Colombia
Cortés Henry, Anesthesiologist and Pain Unit, Fundación Universitaria JN Corpas, Bogotá, Colombia
Abella Patricia, Anesthesiologist and Pain Unit, Fundación Universitaria JN Corpas, Bogotá, Colombia
García Edwin, Odontólogo UNICOC, Máster Terapias Regenerativas PRP en Odontología, Colaborador Unidad del Dolor, Corporación Esimed, Santiago de Cali, Colombia
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It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible. Intervertebral disc disease (IDD) is a progressive, chronic, degenerative disease. Over time, the degeneration worsens and ultimately becomes irreversible. The pathogenesis of IDD involves a complex interplay of inflammatory, immunological, and pressure-related processes. Current treatments for IDD, proposed in most ´consensus protocols´ do not correspond to the pathophysiological process involved in the IDD, as these treatments are mainly focused on relieving pain (palliative pain medicine). Surgical techniques (including fusion, laminectomy, and discectomy), aim to stabilize the spine and/or decompress the spinal or the foraminal canal thus alleviating symptoms, but these techniques are not addressed to regarding the cause of the degeneration, and sometimes even accelerate the degeneration of the adjacent segments. Recently, biological therapies have been attracting more attention in the field of intervertebral disc repair and regeneration. Plasma rich in growth factors (PRGF) has the ability to repair and regenerate bone and condral tissue and has a remarkable neuroprotective and anti-inflammatory actions by modulating the immune response, reversing IDD and relieving the neuropathic pain. Growth factors have been associated with the initiation of a healing cascade that leads to cellular chemotaxis, angiogenesis, synthesis of collagen matrix, and cell proliferation. This paper briefly describes the current understanding of growth factors and our experience with PRGF injected by the epidural route.
Plasma Rich in Growth Factors, Intervertebral Disc Degeneration, Axial Pain
To cite this article
Correa Jose, Cortés Henry, Abella Patricia, García Edwin, Epidural Plasma Rich in Growth Factors for Degenerative Disc Disease: A Valuable Alternative to Conventional “Palliative Medicine”, International Journal of Anesthesia and Clinical Medicine. Vol. 7, No. 1, 2019, pp. 1-6. doi: 10.11648/j.ijacm.20190701.11
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Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine. 1978; 3: 319.
Molinos M, Almeida CR, Caldeira J, Cunha C, Gonçalves RM, Barbosa MA. Inflammation in intervertebral disc degeneration and regeneration. J R Soc Interface. 2015 (6); 12 (104): 20141191.
Smith LJ, Nerurkar NL, Choi K-S, Harfe BD, Elliott DM. Degeneration and regeneration of the intervertebral disc: lessons from development. Dis Model Mech. 2011 Jan; 4 (1): 31–41.
Moore RJ. The vertebral endplate: disc degeneration, disc regeneration. Eur Spine J. 2006 Aug; 15 (Suppl 3): 333–337.
Wang Y, Videman T, Battie MC. ISSLS prize winner: lumbar vertebral endplate lesions: associations with disc degeneration and back pain history. Spine. 2012; 37 (17), 1490–1496.
An HS, Thonar EJ, Masuda K: Biological repair of intervertebral disc. Spine. 2003, 28: S86-S92.
Evans C: Potential biologic therapies for the intervertebral disc. J Bone Joint Surg Am. 2006, 88: 95-98.
Cameron JA, Thielen KM. Autologous platelet rich plasma for neck and lower back pain secondary to spinal disc herniation: midterm results. Spine Res. 2017, Vol 3 No. 2:10.
Levi D, Horn S, Tyszko S, Josh Levin J, Hecht-Leavitt C, Walko E. Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial. Pain Medicine 2016; 17: 1010–1022.
Akeda K, Ohishi K, Masuda K, Bae WC, Takegami N, Yamada J, Nakamura T, Sakakibara T, Kasai Y, Sudo A. Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial. Asian Spine J. 2017 Jun; 11 (3): 380–389.
Shan-Zheng W, Yun-Feng R, Qi T, Chen W. Enhancing intervertebral disc repair and regeneration through biology: platelet-rich plasma as an alternative strategy. Arthritis Res Ther. 2013; 15 (5): 220.
Bhatia R, Chopra G. Efficacy of Platelet Rich Plasma via Lumbar Epidural Route in Chronic Prolapsed Intervertebral Disc Patients-A Pilot Study. J Clin Diagn Res. 2016 Sep; 10 (9): UC05–UC07.
Correa J, Cortés H, Coral O, E. García E. PRP epidural en el manejo de la enfermedad discal degenerativa y dolor axial. Estudio preliminar. Rev. Soc. Esp. Dolor 2017; 24 (2): 85-95.
Anitua E, Padilla S. Biologic therapies to enhance intervertebral disc repair. Regenerative Medicine 2018 vol 13 No. 1.
Nguyen RT, Borg-Stein J, Mcinnis K. Application of platelet-rich plasma in musculoskeletal and sports medicine: An evidence based approach. PM R 2011; 3:226–250.
Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med 2003; 33:381–394.
Rodríguez J, Palomar MA, Torres J. Plasma rico en plaquetas: fundamentos biológicos y aplicaciones en cirugía maxilofacial y estética facial. Rev Esp Cirug Oral y Maxilofac 2012; 34 (1): 8-17.
Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85 (6):638-46.
Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine. J Biol Regul Homeost Agents 2012; 26 (2 Suppl 1):3S-22S.
Sánchez M, Anitua E, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017; 17 (2):197-212.
Sánchez M, Garate A, Delgado D, Padilla S. Platelet-rich plasma, an adjuvant biological therapy to assist peripheral nerve repair. Neural Regen Res. 2017; 12 (1): 47–52.
Anitua E, Pelacho B, Prado R, Aguirre JJ, Sánchez M, Padilla S, Aranguren XL, Abizanda G, Collantes M, Hernandez M, Perez-Ruiz A, Peñuelas I, Orive G, Prosper F. Infiltration of plasma rich in growth factors enhances in vivo angiogenesis and improves reperfusion and tissue remodeling after severe hind limb ischemia. J Control Release. 2015d; 202:31–39.
Dogliotti AM. A new method of block anaesthesia. Segmental peridural spinal anaesthesia. Am J Surg. 1933; 20:107–118.
Zanoli G, Strömqvist B, Jönsson B. Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Spine 2001; 26 (21):2375-80.
Karppinen J, Shen FH, Luk KD, Andersson GB, Cheung KM, Samartzis D. Management of degenerative disk disease and chronic low back pain. Orthop Clin North Am. 2011;15:513–528.
Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, Kalso EA, Loeser JD, Miaskowski C, Nurmikko TJ, Portenoy RK, Rice A, Stacey BR, Treede RD, Turk DC, Wallace MS. Pharmacologic management of neuropathic pain: Evidence-based recommendations. PAIN. 2007; 132 (3): 237–251.
Wanderer JP, Rathmell JP. An Important Step Forward in the Safe Use of Epidural Steroid Injections. Anesthesiology 2014; 121:A23.
Bateman BT, Brenner GJ, An Important Step Forward in the Safe Use of Epidural Steroid Injections. Anesthesiology 2015; 122 (5): 964-966.
Akeda K, Imanishi T, Ohishi K, et al. Intradiscal injection of autologous serum isolated from platelet‐rich‐plasma for the treatment of discogenic low back pain: preliminary prospective clinical trial: GP141. Spine: Affiliated Society Meeting Abstracts 2011.
Monfett M, Harrison J, Boachie-Adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int Orthop. 2016 Jun; 40 (6):1321-1328.
Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R 2016; 8:1-10.
Correa J, Cortés H, García E, Quintero L. Platelet-rich plasma in treating peripheral neuropathic pain. Preliminary report (Plasma rico en plaquetas en el tratamiento del dolor neuropático periférico. Estudio preliminary) Rev. Soc. Esp. Dolor. 2018; 25 (5): 263-270 / DOI: 10.20986/resed. 2017.3625/2017.
Minamide A, Hashizume H, Yoshida M, Kawakami M, Hayashi N, Tamaki T. Effects of basic fibroblast growth factor on spontaneous resorption of herniated intervertebral discs. An experimental study in the rabbit. Spine 1999; 24:940–945.
Rosenstein JM, Krum JM, Ruhrberg C. VEGF in the nervous system. Organogenesis 2010; 6(2): 107114.
Osada R, Ohshima H, Ishihara H, Yudoh K, Sakai K, Matsui H, Tsuji H. Autocrine/paracrine mechanism of insulin-like growth factor-1 secretion, and the effect of insulin-like growth factor-1 on proteoglycan synthesis in bovine intervertebral discs. J Orthop Res. 1996 Sep;14(5):690-699.
Echeverry S, Shi XQ, Haw A, Liu H, Zhang Z, Zhang J. Transforming growth factor-β1 impairs neuropathic pain through pleiotropic effects. Mol Pain. 2009; 5:16. doi: 10.1186/1744-8069-5-16.
Blobe GC, Schiemann WP, Lodish HF. Role of transforming growth factor beta in human disease. N Engl J Med. 2000;342:1350–1358. doi: 10.1056/NEJM200005043421807.
Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992; 268 (17):2420-2425.
Gérvas J, Pérez Fernández M. Uso apropiado de la medicina basada en pruebas revisión de diez artículos recientes. AMF 2005; 1 (1):46-56.
Masic I, Miokovic M, Muhamedagic B. Evidence Based Medicine – New Approaches and Challenges. Acta Inform Med 2008; 16 (4):219-225.
Rice AS, Cimino-Brown D, Eisenach JC, Kontinen VK, Lacroix-Fralish ML, Machin I. Preclinical Pain Consortium, Mogil JS, Stöhr T. Animal models and the prediction of efficacy in clinical trials of analgesic drugs: a critical appraisal and call for uniform reporting standards. Pain 2008; 139 (2):243-247.
Manchikanti L, Hirsch JA, Smith HS. Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: Part 2: Randomized controlled trials. Pain Physician 2008; 11 (6):717-773.
Evidence-Based Medicine Working Group. Evidence based medicine. A new approach to teaching the practice of medicine. JAMA 1992; 268 (17):2420-2425.
Craig JC, Irwig LM, Stockler MR. Evidence-based medicine: useful tools for decision making. MJA 2001; 174 (5):248-253.
Greeno C. Major alternatives to the classic experimental design. Fam Process 2002; 41 (4):733-736.
Lazcano-Ponce E, Salazar-Martínez E, Gutiérrez-Castrellón P, Ángeles-Llerenas A, Hernández-Garduño A, Viramontes JL. Ensayos clínicos aleatorizados: variantes, métodos de aleatorización, análisis, consideraciones éticas y regulación. Salud pública de México 2004; 46 (6):559-584.
Correa J, Abella P. Unidades del Dolor del Siglo XXI. Protocolos de Consenso o Medicina Basada en la Evidencia? Pers. Bioét. 2018; 22 (1): 29-38 DOI: 10.5294/pebi.2018.22.1.3.
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