Bir Seviye Tek Sefer İntradiskal Otolog Plateletten Zengin Plazma Enjeksiyonu Diskojenik Ağrı Tedavisinde Rol Oynayabilir mi? 6. Ay Takip Sonuçları

Yıl 2020, Cilt: 22 Sayı: 1, 39 - 49, 30.04.2020

Ubeydullah Sevgili , Ahmet Sinan Sarı

https://doi.org/10.24938/kutfd.626463

Cited By: 2

Öz

Amaç: Bel ağrısı hem genç hem de yaşlı nüfusta gittikçe artan bir oranda görülmektedir. İntervertebral disk dejenerasyonu neticesinde gelişen diskojenik ağrı, kronik bel ağrısı şikayetlerinin yaklaşık %40’ının sebebidir. Bizim bu çalışmadaki hipotezimiz diskojenik ağrı tedavisinde bir seviye tek sefer otolog intradiskal plateletten zengin plazma (PZP) uygulamasının hastaların fiziksel aktiviteye dönüşü ve ağrı üzerinde belirgin bir iyileşme sağlayabileceğidir.

Gereç ve Yöntemler: Diskojenik ağrı tedavisi için 22 hastaya bir seviye tek sefer 3ml intradiskal otolog platelet zengin plazma (PZP) uygulaması yapıldı. Hastalar tedavi öncesi ve tedaviden 6 ay sonra vizüel analog skor (VAS) ve Oswestry disabilite index (ODI) ile değerlendirildi.

Bulgular: Tedavi öncesi ortalama VAS ve ODI skorları sırası ile 5.6±1.0 ve %55.0 ± %11.6 idi. Tedaviden 6 ay sonra ortalama VAS ve ODI skorları sırası ile 1.3±1.0 ve %23.2 ± %11.2 idi ve fark istatistiksel olarak anlamlı bulundu (p<0.01).

Sonuç: Çalışmamız kronik diskojenik ağrı hastalarında bir seviye tek sefer intradiskal PZP uygulamasının hastaların fiziksel aktiviteye dönüşü ve ağrı üzerinde belirgin bir iyileşme sağlayabileceğini göstermiştir. Intradiskal PZP tedavisnin etkinliğini daha derinlemesine araştırmak için randomize plasebo kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

PZP, intervertebral, disk dejenerasyonu, bel ağrısı, Oswestry Disability Index

Destekleyen Kurum

Yok.

MAY SINGLE ONE LEVEL INTRADISCAL AUTOLOGOUS PLATELET RICH PLASMA INJECTION PLAY A ROLE IN THE TREATMENT OF DISCOGENIC PAIN? RESULTS AT SIX MONTH FOLLOW-UP

Öz

Objective: Low back pain is spreading both in older and younger people in a fast manner. Discogenic pain resulting from degeneration of the intervertebral disc is responsible for 40% or more of the cases of low back pain. We hypothesized that single one level intradiscal autologous platelet rich plasma (PRP) injection might provide remarkable pain relief and return to pre-illness activity level in the patients suffering from discogenic pain.

Material and Methods: Twenty-two patients underwent injections of just one 3ml dose of PRP into one intervertebral disc space (single one level intradiscal autologous PRP injection) for discogenic pain. The patients were evaluated by visual analogue score (VAS) and Oswestry Disability Index (ODI) score before intradiscal PRP treatment and at six months after intradiscal PRP treatment.

Results: The average pre-treatment VAS and ODI scores were 5.6±1.0 and 55.0% ± 11.6% respectively. The average VAS and ODI scores at six months after intradiscal PRP treatment were 1.3±1.0 and 23.2% ± 11.2% respectively and the differences were statistically significant (p<0.01).

Conclusion: The present study demonstrates that single one level intradiscal PRP injection may provide remarkable pain relief and may increase the return to pre-illness activity level in the patients suffering from discogenic pain. For evaluation of the efficacy of this treatment, randomized placebo-controlled trials are needed.

Anahtar Kelimeler

PRP, intervertebral, disc degeneration, Oswestry Disability Index, low back pain

Kaynakça

• 1. Chopra G, Srivastav N. To evaluate the comparative efficacy of various drug combination via epidural route in treatment of pain in patients of intervertebral disc herniation. Journal of Dental and Medical Sciences. 2014;13(3):76-9.
• 2. Vo NV, Hartman RA, Patil PR, Risbud MV, Kletsas D, Iatridis JC et al. Molecular Mechanisms of Biological Aging in Intervertebral Discs. J Orthop Res. 2016;34(8):1289-306.
• 3. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991;22(2):263-71.
• 4. Bhatia R, Chopra G. Efficacy of platelet rich plasma via lumbar epidural route in chronic prolapsed intervertebral disc patients-a pilot study. J Clin Diagn Res. 2016;10(9):UC05-UC07.
• 5. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine (Phila Pa 1976). 1995;20(17):1878-83.
• 6. Levi D, Horn S, Tyszko S, Levin J, Hecht-Leavitt C, Walko E. Intradiscal platelet-rich plasma injection for chronic discogenic low back pain: preliminary results from a prospective trial. Pain Med. 2016;17(6):1010-22.
• 7. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine (Phila Pa 1976). 2005;30(24):2817-23.
• 8. Dunn KM, Hestbaek L, Cassidy JD. Low back pain across the life course. Best Pract Res Clin. Rheumatol. 2013;27(5):591-600.
• 9. Rothman RH. A study of computer-assisted tomography. Spine (Phila Pa 1976). 1984;9(6):548.
• 10. Mohammed S, Yu J. Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain. J Spine Surg. 2018;4(1):115-122.
• 11. Nguyen RT, Borg-Stein J, McInnis K. Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach. PM R. 2011;3(3):226-50.
• 12. Canbeyli ID, Akgun RC, Sahin O, Terzi A, Tuncay IC. Platelet-rich plasma decreases fibroblastic activity and woven bone formation with no significant immunohistochemical effect on long-bone healing: An experimental animal study with radiological outcomes. J Orthop Surg (Hong Kong). 2018;26(3):2309499018802491.
• 13. Anitua E, Andía I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res. 2005;23(2):281-6.
• 14. Mlynarek RA, Kuhn AW, Bedi A. Platelet-Rich Plasma (PRP) in orthopedic sports medicine. Am J Orthop (Belle Mead NJ). 2016;45(5):290-326.
• 15. Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, Harrison JR, Gribbin CK, LaSalle EE et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R. 2016;8(1):1-10; quiz 10.
• 16. Young S, Aprill CN, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine J. 2003;3(6):460-5.
• 17. Bogduk N, Aprill CN, Derby R. Lumbar discogenic pain: State-of-the-art review. Pain Med. 2013;14(6):813-36.
• 18. Akeda K, Ohishi K, Masuda K, Bae WC, Takegami N, Yamada J et al. Intradiscal injection of autologous platelet-rich plasma releasate to treat discogenic low back pain: a preliminary clinical trial. Asian Spine J. 2017;11(3):380-9.
• 19. Bodor M, Toy A, Aufiero D. Platelet-rich plasma: regenerative medicine: sports medicine, orthopaedic, and recovery of musculoskeletal injuries. Disc regeneration with platelets and growth factors. Springer, Berlin, Heidelberg. 2014:265-279.