Millions of Americans suffer from back pain, and in many instances the root of the pain is Degenerative Disc Disease (DDD). DDD is a condition where the intervertebral discs — fibrous pads of cartilage that act as shock absorbers between bones of the spine — start to break down or wear out.
This wearing of the discs causes inflammation and a loss of structural integrity, which puts pressure on spinal nerves causing pain. In many cases, the pain can be debilitating. While in some cases DDD is caused by a combination of genetic factors and normal ageing of the spine, it can also be brought on in young and middle-aged adults by sudden or repetitive injury to the back. It is commonly initiated by sports-related injuries in both athletes and novice participants alike.
In the case of injury acquired DDD, frequent strain on the back can cause wear and small tears in the discs. These tears are difficult to heal since the fibrocartilage tissue that comprises intervertebral discs does not have blood vessels to carry nutrients and factors that promote healing to the cells.
Recent advances in biologics therapies — medical treatments that utilize the body’s natural healing mechanisms against specific injuries and illnesses — have uncovered a powerful treatment to promote tissue repair called platelet-rich plasma (PRP) treatment. The body’s normal process of healing from injury includes the activation of platelets, small cell fragments that circulate in the blood.
Within these fragments are granules containing several different growth factors that have been shown to direct the healing process through stimulation of new cell growth and repair. When platelets are activated, they release these granules to promote rapid healing. In contrast to isolated growth factors, platelets and plasma contain activating compounds that further enhance the healing process.
In the case of degenerative disc disease, pain can be alleviated temporarily through avoidance of activity, use of pain-management medication, or steroid injections, but the actual damage to discs is not repaired and disc degeneration typically continues to progress over time. The use of PRP therapy is a great option for complex conditions such as DDD that do not have long-term success with treatments such as physical therapy and pain management, or for patients facing surgery as an option.
Doctors may suggest PRP for treatment in cases when other treatments have failed to provide relief. In addition, physicians may utilize PRP in patients with early stages of DDD where repair of minor tissue damage may help to prevent further disease progression.
Treatment with PRP: Preparation and Procedure
Treatment of DDD with PRP is non-surgical, can be done on an out-patient basis, takes only about an hour, and requires very little down time. The procedure starts by removing a small amount of the patient’s own blood using a syringe like the type typically used when drawing blood for common lab tests.
Human blood is comprised of several different elements: white blood cells, red blood cells, platelets, and proteins all suspended in a watery liquid called plasma. Because of differences in density, the various components can be separated out using centrifugation, a process by which a rapidly spinning rotor allows centrifugal force to pull the more dense components toward the bottom of the rotor, allowing lighter — less dense — components to remain near the top.
Once blood is drawn, it is placed in vials in a centrifuge and spun at high speeds to separate out the denser red blood cells from the less-dense white cells and platelets, leaving the least dense layer containing plasma at the top. After centrifugation, the platelet layer is combined with the plasma to form platelet-rich plasma.
The PRP is injected directly into the inter-vertebral disc using fluoroscopic guidance — an imaging technique permitting visualization throughout the procedure—to allow for precise placement of the injections.
PRP Injection for Degenerative Disc Disease
- a vial of venous blood is removed from the patient (usually from a vein in the arm)
- the blood is centrifuged to separate the components and the plasma and platelet components are combined and placed into a new syringe
- the patient is taken into a radiology facility for use of the imaging equipment to guide the injections
- the injection site is prepped and cleaned to reduce the chance of infection
- a local anesthetic is typically applied to the site of injection to minimize discomfort
- using imaging techniques to guide precise placement, PRP is injected directly into affected inter-vertebral discs
- after injection, the needle is removed and the patient will rest shortly before being able to go home
After treatment: what to expect
Immediately following treatment, over the next few days, the site of the injection may be sore and slight bruising may be evident. Over-the-counter analgesics such as acetaminophen may be used, but non-steroidal anti-inflammatory medications like ibuprofen should be avoided both immediately before and during treatment.
For more moderate pain, pain-relief medications may be prescribed. Ice can be applied for pain and swelling. During this period, the patient should rest, limit physical activity, and avoid strenuous exercise and heavy lifting.
After 2-3 days and up to 2 weeks post-injection, the goal is to increase tolerance to daily activities and the patient should start being more active as tolerated. During this period, the physician may advise daily stretching and range-of-motion exercises.
While some patients experience some relief after just one injection, comprehensive treatment typically requires anywhere from 2 to 6 injections, with 4 to 6 weeks of healing time in between.
Why choose platelet-rich plasma as a treatment?
PRP offers many benefits as a treatment for degenerative disc disease. Conventional non-surgical treatments for DDD treat the symptoms but do not heal damage to the discs.
Since the cartilage that makes up the discs is non-vascular, that is — is does not have blood supply running through it — the cells in the discs are not exposed to platelets and growth factors that circulate in the blood and promote generation of new cells and repair of damaged tissue. By injecting PRP directly into the intervertebral discs, the healing benefits of platelets and growth factors can be delivered to this area without circulation.
Surgical treatments can attempt to repair damage, but do not heal the tissue or stop further damage from occurring. PRP has many advantages over surgical treatments including a reduced risk associated with having an injection rather than an incision, less pain associated with the procedure, a shorter recovery period, and reduced costs associated with PRP compared to surgery.
Overall, physicians may recommend platelet-rich plasma as a treatment for degenerative disc disease as it is a convenient, minimally-invasive procedure that not only alleviates pain, but also promotes repair of damaged tissue. PRP has the potential for long-term relief without the high risk and long recovery period associated with surgery.