Annu Navani, Comprehensive Spine and Sports Center, Campbell, CA
“We presented data on a cohort of patients treated with epidural PRP who presented with radicular pain who had non-sustainable benefits from an epidural steroid injection. 70% of patients had >50% relief in VAS up to 18 months. Results compare favorably to age-matched controls given epidural steroids. There were no adverse reactions in patients treated with epidural PRP.”
Rahul Desai, MD, RestorePDX, Beaverton, OR
Post regenerative injection MRI imaging of the spine for disc herniation is showing some encouraging findings correlating with improved pain and function. More controlled trials are needed.
Gregory E. Lutz, MA
, Hospital for Special Surgey, New York, NY
The importance of solid data cannot be understated for advancing the field of regenerative spine care. Our randomized, double blinded controlled trial for discogenic low back pain compared intradiscal PRP versus controls receiving only intradiscal contrast. Participants who received intradiscal PRP showed significant improvements in function, pain, and satisfaction scores over eight weeks when compared to controls. A recent update on this research has shown persistent improvements up to 2 years (http://link.springer.com/article/10.1007%2Fs00264-016-3178-3
CARTILAGE & BONE
Johnny Huard, PhD, University of Texas Health Science Center, Houston, TX
In rabbit models of cartilage injury and regeneration, muscle-derived stem cells (MDSC) produce levels and ratios of collagen I and II similar to that produced by chondrocytes. The implication is that MDSCs may have the optimal potential for producing more functional cartilage tissue compared to other stem-cell derivatives (i.e. adipose/ marrow). Cytokine augmentation of this process in vitro shows that the most optimal cartilage is obtained by adding BMP-4, and then blocking angiogenesis by using soluble fms-like tyrosine kinase-1 (s-Flt-1).
Henning Madry, MD, Institute for Experimental Orthopaedics and Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, GERMANY
Research has recently begun to recognize that subchondral bone plays a major role in cartilage repair. Four Different patterns of subchondral bone alterations have been observed after regenerative treatments : (1) Upward migration, subchondral bone plate, (2) Intralesional osteophytes, (3) Subchondral bone cysts, and (4) Changes in subchondral bone microarchitecture. While much research has been done in animal models regarding this alterations, clinical studies are needed to further verify their clinical impact.
Nicolas Fiz, MD, Trauma Santiago Apostol Hospital
The human knee joint can be thought of an organ, with functional contributions from cartilage, synovial membrane, and subchondral bone tissues, and therefore osteoarthritis can be thought of as an “organ failure”. We believe that addressing both intra-articular and intra-osseuous structures may be necessary for more comprehensive treatment of osteoarthritis. Interim analysis of our phase II study for intra-articular AND subchondral bone infiltration with leukocyte-reduced PRP have shown promising results. No adverse reactions were noted, and statistically significant improvements were seen in both pain and functional rating scores.
Also, we highlighted situations where certain patients can have low growth factor assays despite good platelet counts. In one case of a non-healing wound post PRP treatment, further analysis of the platelets revealed normal thrombocyte counts but low VEGF levels. This may call into question what we currently label “treatment failures” in regenerative medicine.