Regenerative Medicine for Axial and Radicular Spine-Related Pain: A Narrative Review

Mehul J Desai; John Taylor Mansfield; David M Robinson; Benjamin C Miller; Joanne Borg-Stein

doi:10.1111/papr.12868

Regenerative Medicine for Axial and Radicular Spine-Related Pain: A Narrative Review

Pain Pract. 2020 Apr;20(4):437-453. doi: 10.1111/papr.12868. Epub 2020 Jan 28.

Authors

Mehul J Desai^{1

2

3}, John Taylor Mansfield⁴, David M Robinson⁵, Benjamin C Miller⁴, Joanne Borg-Stein⁶

Affiliations

¹ International Spine, Pain & Performance Center, Washington, DC, U.S.A.
² George Washington University, Washington, DC, U.S.A.
³ Division of Pain Medicine, Virginia Hospital Center, Arlington, Virginia, U.S.A.
⁴ Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital, Washington, DC, U.S.A.
⁵ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, U.S.A.
⁶ Division of Sports and Musculoskeletal Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, U.S.A.

PMID: 31869517
DOI: 10.1111/papr.12868

Abstract

Introduction: Regenerative injection-based therapy has established itself as a therapeutic option for the management of a variety of painful musculoskeletal conditions. The aim of this work was to review the current literature regarding regenerative injection therapy for axial/radicular spine pain.

Methods: A comprehensive literature review was conducted on the use of regenerative medicine for axial/radicular spine pain. Eligible articles analyzed the therapeutic injection effects of platelet-rich plasma (PRP), prolotherapy, or mesenchymal signaling cells (MSCs) via intradiscal, facet joint, epidural, or sacroiliac joint delivery.

Results: Regarding intradiscal PRP, there are level I/IV studies supporting its use. Regarding intradiscal prolotherapy, there are level III to IV studies supporting its use. Regarding intradiscal MSCs, there are level I/IV studies supporting its use with the exception of one level IV study that found no significant improvement at 12 months. Regarding facet joint injections with PRP, there are level I/IV studies supporting its use. Regarding facet joint injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate any statistical significance supporting its use. Regarding epidural injections with PRP, there are level I/IV studies supporting its use. Regarding epidural injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate statistical significance beyond 48 hours. Regarding sacroiliac joint injections with PRP, there are level I/IV studies supporting its use. Regarding sacroiliac joint injections with prolotherapy, there are level I/III studies supporting its use.

Conclusions: Currently, there are level I studies to support the use of PRP and MSC injections for discogenic pain; facet joint injections with PRP; epidural injections of autologous conditioned serum and epidural prolotherapy; and PRP and prolotherapy for sacroiliac joint pain. One level I study showed that facet joint prolotherapy has no significant benefit. Notably, no intervention has multiple published level I studies.

Keywords: back pain; medicinal signaling cells; mesenchymal stem cells; orthobiologics; platelet-rich plasma; prolotherapy; radicular pain; regenerative medicine.

Publication types

Review

MeSH terms

Back Pain / therapy*
Humans
Injections, Epidural
Injections, Intra-Articular
Mesenchymal Stem Cell Transplantation / methods*
Pain Management / methods*
Platelet-Rich Plasma*
Prolotherapy / methods*
Regenerative Medicine / methods