Lower back pain is a fairly common condition affecting millions around the globe, with the older and younger population falling victim to it alike. In most of the persistent and long-term cases, the pain originates from Degenerative Disc Disease (DDD). DDD is a condition in which fibrocartilaginous intervertebral discs, that support the vertebral column and act as shock absorbers, sustain the damage, and start to wear and tear. Injury to the intervertebral discs incites an inflammatory response and formation of granulation tissues in an attempt to fix the damage. The structural integrity of the discs thus compromised, puts pressure on spinal nerves running around it. In many cases, the pain can be severely debilitating leading to a number of negative effects on the life of the sufferer. The back pain arising from Degenerative Disc Disease is called ‘discogenic’ in origin.
Most frequently, it is age-related, however, genetic factors can also play an important role. In young and middle-aged adults, it is mostly caused by sudden blunt or repeated injury. Sports injuries are the most common cause among the young population. Damages to the fibrocartilage of intervertebral discs, physical injury-acquired or age-related, are very difficult to heal as the tissue is avascular (deprived of blood vessels) and nutrients and healing factors cannot be carried to the disc via blood. For the same reason, many people have to live with pain-killers, with no permanent solution. Other currently available options include surgery and physical therapy and even these only help in relieving the symptoms having no effect on the underlying cause.
Platelet-rich Plasma (PRP)
Platelet-rich Plasma (PRP) is derived from the autologous blood (the blood from the recipient of the treatment) and contains a significantly higher concentration of platelets compared to the normal physiological levels. It is obtained by centrifugation that separates the liquid and solid components of the blood (i-e plasma and blood cells), into different layers by their density. PRP is constructed around manipulating the body’s natural healing mechanisms to our advantage, especially for the most resistant injuries to the avascular areas of the body.
Platelets, that are plentiful in PRP, are rich in growth factors and that are released by them to promote tissue repair and growth by stimulating cellular mechanisms vital for healing and regeneration. Through a number of mechanisms stirred by these growth factors, PRP can significantly restore the integrity of degenerating intervertebral discs. Platelets are also involved in the regulation of inflammatory response to the disc injury, thus ameliorating the inflammation-induced damage.
Owing to a lack of interventional techniques, DDD usually progresses over time and becomes debilitating. PRP can serve as a promising treatment option in this case, especially during the earlier stages, halting the progression and promoting healing.
Treatment of DDD with PRP
After the blood is withdrawn from the patient, it is rotated in a centrifuge to allow the separation of different density components. The plasma and platelets thus separated are combined to form PRP. It is a non-surgical, outpatient procedure with insignificant downtime. The amount of blood required is minimal usually not exceeding the amount that is required for common lab tests.
The PRP obtained is directly injected into the intervertebral disc and the process is guided by fluoroscopy, an imaging technique helpful for the proper placements of the injections.
The whole procedure can be summarized as below:
- The patient is taken to the procedure room, a vial of blood is withdrawn
- The blood is centrifuged to separate platelet-rich plasma that will be used for the treatment
- After the PRP is prepared, the patient is taken to the radiology room to allow the guided administration of the injection using an imaging technique
- The injection site is prepared by disinfection to avoid infections
- A local anesthetic is typically used to minimize the discomfort associated with the procedure.
- Using the imaging technique, the PRP injection is directly placed into the damaged intervertebral disc
- After the injection, the patient is allowed to rest for a while and can leave as soon as he feels better
After the Treatment
As evident, PRP treatment is a minor procedure requiring little treatment and recovery time. It is safe and effective and only minor discomfort such as bruising, pain, and numbness in legs is experienced in some cases, that too for a short while. Usually, over the counter analgesics are all that is required during the recovery period. NSAIDs, e-g ibuprofen, should be avoided before and during the treatment. It is recommended to limit the physical activity and strenuous exercise shortly after the procedure. Taking rest immediately after can facilitate the process of regeneration and recovery. For some patients, even one injection can significantly promote healing and lessen the pain. In most cases, however, 2-6 injections stretched over a course of months with a healing time of around 4-6 weeks in between are required.
PRP- A Superior Solution
PRP offers a superior solution to surgery and other interventions as it treats the underlying cause and not merely the symptoms. It provides a non-invasive alternative to patients who have been living with back pain for years to avoid the surgery. The ability of the fibrocartilaginous tissue of intervertebral discs is limited owing to a lack of blood supply. With PRP, the healing properties of the body can be used even in areas that are not supplied by nutrients and growth factors.
PRP is also preferable over the surgery as it can prevent further damage along with the regression of the existing one. The same cannot be guaranteed with surgery. The patient also only experiences minor discomfort compared to a large surgical scar and an extended recovery time associated with surgery.
Another significant advantage of the procedure is the safety of the autologous PRP used. Since it is derived from the patient, there is no risk for the transmission of infections and adverse allergic reactions. These advantageous effects of PRP for discogenic back pain are backed by a number of studies showing significant improvement in the pain intensity for the patients. The remarkable effects of PRP allow the patients to return to a normal level of physical activity finally breaking free from a debilitating lifestyle.
PRP therapy is also cost-effective as the treatment agent is autologous in origin, simple, and easy to obtain and use. It also saves the costs for a pharmacological treatment that would likely be stretched over a lifetime if a permanent solution is not sought. The process of PRP therapy can be further simplified by using a commercial kit.