Rawson B. Platelet-Rich Plasma and Epidural Platelet Lysate: Novel Treatment for Lumbar Disk Herniation. J Am Osteopath Assoc 2020;120(3):201–207. doi: https://doi.org/10.7556/jaoa.2020.032.
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Lumbar herniated disks present a common cause of significant axial low back and radiating leg pain. This situation poses a risk for potentially permanent neurologic compromise, including numbness, weakness, and bowel and bladder dysfunction. Traditional treatment strategies such as medications, epidural steroids, and surgery all carry potential risk for iatrogenic sequelae. Platelet-rich plasma can be processed to isolate and concentrate the growth factors contained in platelet α granules. This solution is then referred to as platelet lysate. Lumbar injection of platelet-rich plasma along with epidural injection of platelet lysate is a novel therapeutic option that can initiate or expedite the resorption of herniated lumbar disk material, which can facilitate the decompression of the affected spinal structures. This process is thought to occur through a complex interplay of cytokines and growth factors that facilitate neovascularization along with macrophage-induced phagocytosis of the disk material. In the present report, we describe 2 patients with symptomatic herniated disks who were successfully treated with epidural injection of growth factors derived from concentrated platelet lysate.
a Mean concentrations produced by author's laboratory compared with baseline levels.
Abbreviations: BDNF, bone-derived growth factor; IL-1 RA, interleukin -1 receptor antagonist; EGF, epidermal growth factor; HB-EGF, heparin-binding EGF-like growth factor; PDGF-BB, platelet-derived growth factor with 2 β subunits; PRP, platelet-rich plasma; VEGF, vascular endothelial growth factor.
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