Application of platelet-rich plasma in the support and treatment of degenerative disc disease

Post of MSc. Nguyen Dac Tu, Product Quality Evaluation Team Leader and MSc. Pham Thi Thanh, Product Quality Assessment Specialist, Vinmec
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Platelet-rich plasma (PRP) is known as a safe and effective autologous therapy when it is widely used in many medical fields ranging from maxillofacial surgery to dental surgery. Treatment of hair loss and baldness. With musculoskeletal diseases, PRP is mainly used to support and treat degenerative disc disease and spine disease.

Spinal disc degeneration (IDD) is a phenomenon where the structure of the discs is gradually worn down over time, the disc function is degraded. This disease usually occurs in the elderly due to the aging process, however, young people can also experience it when trauma causes the outer fibrous capsule to tear and destroy the inner mucous nucleus.
Degenerative disc causes extremely uncomfortable pain, interferes with mobility and greatly affects the quality of daily life. The aging process, lifestyle habits, endothelial changes and genetic factors can all influence disc degeneration. The degenerative process results in a large decrease in the number of active endothelial cells in the disc region, the depletion of the extracellular matrix and the appearance of inflammatory cytokines that affect the structure and function of the disc.

Currently, treatments for IDD include physical therapy and the use of anti-inflammatory drugs. Using anti-inflammatory drugs helps relieve pain quickly, but often causes effects on the digestive system or liver and kidneys. In case of severe progression, surgical intervention is required, but complications can occur and accelerate the degeneration process. Therefore, the criteria for choosing an effective IDD treatment method is to minimize possible complications, reduce swelling and pain and, importantly, prevent the aging process.

Platelet-rich plasma (PRP) is the product of autologous blood containing large amounts of growth factors, cytokines and chemokines involved in many important processes such as wound healing and tissue regeneration. Numerous in vitro and in vivo studies have demonstrated that the growth factors present in the PRP sample stimulate cell division and maintain the intradiscal level.
In 2011, the first clinical evidence of Akeda et al. demonstrating the use of PRP for low back pain in 6 patients [1]. After 6 months of treatment, all patients confirmed that pain symptoms were significantly reduced and no complications occurred. In 2014, Bodor evaluated the effectiveness of PRP injection for 35 patients with disc degeneration, 2/3 of the patients gave positive feedback [2]. After a follow-up period from 10 days to 10 months, it was found that the pain symptoms were significantly reduced, the treatment time was shortened and the patients quickly returned to their daily lives. In 2016, Levi used injectable PRP for 22 patients, after 6 months of follow-up, pain symptoms were reduced by 50% and no complications occurred [3]. Navani and Hames also reported similar results when using PRP to treat 6 patients, after 6 months of follow-up with a single injection of PRP, 50% of swelling and pain phenomena were significantly reduced. In 2016, Hussein evaluated the effectiveness of PRP treatment for 104 patients, after 6 weeks, 71.2% of the symptoms of swelling and pain were significantly reduced, the recovery time was fast and no complications occurred [4]. After that, many clinical reports have also shown the safety and effectiveness of PRP therapy in the treatment of low back pain, especially degenerative disc disease.
Preclinical and clinical studies have demonstrated that the application of platelet-rich plasma (PRP) has a positive effect in the treatment of degenerative disc disease, helping to reduce symptoms of swelling, pain and improve function movement, helping patients quickly return to daily life. The advantages of PRP therapy are that it minimizes the risk of infectious diseases, does not cause an immune response and promotes wound healing according to the most natural mechanism. PRP is the potential autologous therapy in the treatment of degenerative disc disease and other musculoskeletal diseases.

References
Akeda K, et al (2011), “Intradiscal injection of autologous serum isolated from platelet-rich plasma for the treatment of discogenic low back pain: preliminary prospective clinical trial”, Spine: Affiliated Society Meeting Abstracts 2011. Bodor M, et al (2014), “Disc regeneration with platelets and growth factors”, Springer, 265-279. Levi D, et al (2016), “Intradiscal Platelet rich plasma injection for chronic discogenic low back pain: preliminary results from a prospective trial”, Pain Med, 17, 1010-1022. Hussein M, et al (2016), “Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental decaying disc disease”, SICOT J, 2:12.