RESUMEN
BACKGROUND: Low back pain (LBP) has a high economic burden and is strongly related to the degenerative process of the spine, especially in the intervertebral disc and of the facet joints. Numerous treatment modalities have been proposed for the management of LBP, and the use of platelet-rich plasma (PRP) has emerged as an innovative therapeutic option for degenerative disease of the spine. The present study aims to evaluate the efficacy of PRP injections in managing low back pain. METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a registered at PROSPERO Systematic Reviews Platform, under number CRD42021268491. The PubMed, Web of Science, and Scopus databases were searched to identify relevant articles, along with hand searching to identify gray literature articles, with no language restrictions. Randomized clinical trials (RCTs), nonrandomized trials (NRTs), and case series (CSs) with more than 10 patients were considered eligible. The quality assessment and the risk of bias of the randomized clinical trials were evaluated using the RoB II tool. An evaluation of the description of the preparation methods was performed using an adapted version of the MIBO checklist. RESULTS: An electronic database search resulted in 2324 articles, and after the exclusion of noneligible articles, 13 RCTs and 27 NRTs or CSs were analyzed. Of the 13 RCTs, 11 found favorable results in comparison to the control group in pain and disability, one showed no superiority to the control group, and one was discontinued because of the lack of therapeutic effect at eight-week evaluation. Description of the PRP preparation techniques were found in almost all papers. The overall risk of bias was considered high in 2 papers and low in 11. An adapted MIBO checklist showed a 72.7% compliance rate in the selected areas. CONCLUSIONS: In this systematic review, we analyzed articles from English, Spanish and Russian language, from large databases and grey literature. PRP was in general an effective and safe treatment for degenerative LPB. Positive results were found in almost studies, a small number of adverse events were related, the risk of bias of the RCTs was low. Based on the evaluation of the included studies, we graded as level II the quality of the evidence supporting the use of PRP in LBP. Large-scale, multicenter RCTs are still needed to confirm these findings.
RESUMEN
In the last decade, several studies have demonstrated Cutibacterium acnes colonization in intervertebral discs (IVDs) in patients with lumbar disc degeneration (LDD) and low back pain (LBP), but the meaning of these findings remains unclear. Being aware of this knowledge gap, we are currently conducting a prospective analytical cohort study with LBP and LDD patients undergoing lumbar microdiscectomy and posterior fusion. The IVDs samples collected during the surgeries are subjected to a stringent analytical protocol using microbiological, phenotypic, genotypic, and multiomic techniques. Additionally, pain-related scores and quality-of-life indexes are monitored during patient follow-up. Our preliminary results for 265 samples (53 discs from 23 patients) revealed a C. acnes prevalence of 34.8%, among which the phylotypes IB and II were the most commonly isolated. The incidence of neuropathic pain was significantly higher in the colonized patients, especially between the third and sixth postoperative months, which strongly suggests that the pathogen plays an important role in the chronicity of LBP. The future results of our protocol will help us to understand how C. acnes contributes to transforming inflammatory/nociceptive pain into neuropathic pain and, hopefully, will help us to find a biomarker capable of predicting the risk of chronic LBP in this scenario.
RESUMEN
Objetivo: Se trata de una síntesis del tratamiento elegido con Ozono para las afecciones tipo hernias discales contenidas no protruidas del segmento lumbar bajo y de patologías degenerativas de dicho segmento que son causa de dolor discogénico lumbar y cervical. Metodología: Esta técnica se practica en la unidad de Hemodinamia, por el contrario, con un excelente equipo de arco en C y por la facilidad de guardar en CD todo el procedimiento y otorgarle al paciente una copia del mismo. Muestro un resultado basado en la VAS y Test de Oswestry antes y después de varias sesiones de Ozonoterapia paravertebral adicional a aquellos casos que fueros objeto de Disconucleolisis Percutáneas. Conclusiones: Resultados halagadores de mucha satisfacción convirtiéndose esta técnica en una alternativa mas para el tratamiento de estas afecciones de la Columna Vertebral afectada por las referidas entidades(AU)
Objective: This is a summary of the chosen treatment for conditions such Ozone herniated discs contained no low back protruded segment and that segment degenerative diseases that cause Lumbar and Cervical discogenic pain. Methodology: This technique is practical in the Hemodynamics unit for ease of CD store in the whole procedure and gives the patient a copy of it. Show a score based on VAS before and after several sessions of paravertebral Ozone additional cases that Percutanes Disconucleolisis object privileges. Conclusions: Results satisfacion becoming very flattering of this technique in an alternative one for the treatment of these conditions of Spine(AU)