However, there is limited data showing its effectiveness for the treatment of intervertebral disc degeneration and low back pain. PRP has been effectively used for the treatment of rotator cuff tears, osteoarthritis of the knee, ulnar collateral ligament tears, lateral epicondylitis, hamstring injuries and Achilles tendinopathy ( 21). Tissue regeneration in musculoskeletal conditions is achieved by injecting PRP percutaneously. In recent years, PRP injections have gained considerable attention as a treatment method for musculoskeletal conditions due to their safety and ability to potentially enhance soft tissue healing. It is obtained by a centrifugation process which separates the liquid and solid components of blood ( 19, 20). PRP is defined as autologous blood with platelet concentrations above the physiological baseline. Accordingly, increased attention has been given to emerging techniques such as growth factor therapy, and biomolecular and cellular treatments. This clearly indicates the need for new therapies and/or interventions that actually treat the underlying causes of discogenic pain. Notably, these treatments do not improve the underlying degenerative condition, although they do resolve its symptoms ( 12). Alternatively, non-invasive methods such as benign neglect, physical therapy or symptom control with medication or injection have been employed to treat discogenic pain. The reliability and effectiveness of these surgical procedures are still debated, as they are reported to only offer pain relief ( 9). Since it is widely believed that degenerated discs are the source of discogenic pain, treatments mostly focus on surgical procedures such as fusion and total disc replacement. ( 11), a number of methods are used for the management of discogenic low back pain ( Table 1). Rather than simply providing symptomatic relief, it is important to understand the pathophysiology of degenerated discs to determine the most effective treatment of the underlying cause.Ĭurrent treatments for discogenic back painĪs extensively reviewed by Raj et al. Disc degeneration can also be caused by aging, apoptosis, vascular ingrowth, failure of nutrient supply to disc cells, abnormal mechanical loads or genetic factors ( 7, 10). Nociceptive stimuli include pro-inflammatory cytokines produced by disc cells, interferon-γ, tumor necrosis factor (TNF)-α, downstream signaling molecules such as nitric oxide (NO), leukotrienes, prostaglandin E and by-products of disc cell metabolism such as lactic acid ( 9). Histologic examination of painful discs has revealed the formation of a zone of vascularized granulation tissue extending from the nucleus pulposus to the outer part of the annulus fibrosus along the edges of the annular fissures, and growth of nerves deep into the annulus fibrosus and nucleus pulposus ( 8).ĭisc degeneration is accompanied by changes in the matrixes of both the nucleus pulposus and the inner annulus fibrosus that are mediated by an inflammatory process ( 9). ( 7) reported that various biochemical changes occur during disc degeneration, including loss of proteoglycan, loss of collagen fibers, increased fibronectin, increased enzymatic activity, increased fragmentation of collagen, proteoglycan and fibronectin, and changes in nutritional pathways. Due to the avascular nature of intervertebral discs and, hence, their limited ability to regenerate, research on the regeneration of intervertebral discs and the various associated treatment methods has increased. Reported pathologic features of painful discs include the formation of zones of vascularized granulation tissue with extensive innervation in annular fissures ( 6). Intervertebral disc degeneration can be described as an active process involving changes in tissue and the cellular microenvironment that eventually lead to structural breakdown and impairment of intervertebral disc function ( 5). Interestingly, degeneration, endplate injury and inflammation can stimulate pain receptors inside the disc, leaving the external disc intact ( 4). Stimulation of the nociceptors in the annulus fibrosus causes pain, which is termed “discogenic” pain ( 3). One of the major causes of low back pain is age-associated intervertebral disc degeneration ( 1, 2), which affects the nervous system around the disc. Low back pain is one of the major causes of physical disability affecting both older and younger people and can have enormous socioeconomic and health impacts.
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