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. 2024 Mar 18;7(1):e1320.
doi: 10.1002/jsp2.1320. eCollection 2024 Mar.

Intradiscal administration of autologous platelet-rich plasma in patients with Modic type 1 associated low back pain: A prospective pilot study

Soya Kawabata  1 , Sota Nagai  1 , Kei Ito  1 , Hiroki Takeda  2 , Daiki Ikeda  1 , Yusuke Kawano  1 , Shinjiro Kaneko  2 , Yukako Shiraishi  3 , Yuichiro Sano  4 , Yoshiharu Ohno  5   6 , Nobuyuki Fujita  1
Affiliations

Intradiscal administration of autologous platelet-rich plasma in patients with Modic type 1 associated low back pain: A prospective pilot study

Soya Kawabata et al. JOR Spine. .

Abstract

Background: Various treatments for chronic low back pain (LBP) have been reported; among them, platelet-rich plasma (PRP) as a regenerative medicine has attracted much attention. Although Modic type 1 change (MC1) is associated with LBP, no treatment has been established so far. In addition, no studies have administered PRP to intervertebral discs (IVDs) in patients with LBP, targeting MC1 only. Thus, the purpose of this study was to determine the safety and efficacy of PRP administration to the IVDs in patients with MC1 experiencing LBP.

Methods: PRP was injected intradiscally to 10 patients with MC1 experiencing LBP. Patients were followed prospectively for up to 24 weeks after primary administration. Physical condition, laboratory data, and lumbar x-ray images were evaluated for safety assessment. Furthermore, to evaluate the effectiveness of PRP, patient-reported outcomes were considered. In addition, changes in MC1 were assessed using magnetic resonance imaging (MRI).

Results: There were no adverse events in the laboratory data or lumbar X-ray images after administration. The mean visual analog scale, which was 70.0 ± 13.3 before the treatment, significantly decreased 1 week after PRP administration and was 39.0 ± 28.8 at the last observation. Oswestry disability index and Roland Morris disability questionnaire scores promptly improved after treatment, and both improved significantly 24 weeks after PRP administration. Follow-up MRI 24 weeks after treatment showed a significant decrease in the mean high-signal intensity of fat-suppressed T2-weighted imaging from 10.1 to 7.90 mm2 compared with that before PRP administration.

Conclusions: The safety and efficacy of PRP administration to the IVDs of patients with MC1 experiencing LBP were identified. Post-treatment MRI suggested improvement in inflammation, speculating that PRP suppressed inflammation and consequently relieved the patient's symptoms. Despite the small number of patients, this treatment is promising for patients with MC1 experiencing LBP. The study protocol has been reviewed and approved by the Certified Committee for Regenerative Medicine and the Japanese Ministry of Health, Labor and Welfare (Japan Registry of Clinical Trials [jRCT] No. jRCTb042210159).

Keywords: Modic type 1change (MC1); intervertebral disc (IVDs); low back pain (LBP); platelet‐rich plasma (PRP); regenerative medicines.

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Conflict of interest statement

The research institution received research support from Zimmer Biomet. This study was technically supported by Canon Medical Systems Corporation. Dr. Yoshiharu Ohno has a research grant from Canon Medical Systems Corporation.

Figures

FIGURE 1
FIGURE 1
Flowchart from patient selection to analysis. Ten patients were registered in the prospective study, and none dropped out. LBP, low back pain; MC1, Modic type 1 change.
FIGURE 2
FIGURE 2
Region of interest for measuring T2* values. The entirety of the two vertebrae showing Modic changes was set as the region of interest (blue regions) when measuring T2* values.
FIGURE 3
FIGURE 3
Changes in mean visual analog scale (VAS), Oswestry disability index (ODI), and Roland Morris disability questionnaire (RDQ). Values are presented as mean ± standard deviations. The mean VAS before treatment was 70.0 ± 13.3, which decreased significantly 1 week after administration, and was 39.0 ± 28.8 at the last observation. ODI and RDQ improved promptly after administration. At the last observation, both improved with significant differences.
FIGURE 4
FIGURE 4
Representative images of fat*suppressed T2‐weighted imaging (T2WI) before and 24 weeks after treatment. Fat‐suppressed T2WI high volume (red color regions) decreased from 6.55 to 3.13 mm2.
See this image and copyright information in PMC

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