Low Quality Evidence Found for Intradiscal Biologics for Low Back Pain

A systematic review found limited support for intradiscal biologic agent treatment for discogenic low back pain (LBP). These findings were published in The Spine Journal.

Publication databases were searched in December 2018 and again in April 2020 for studies evaluating treatments for patients with discogenic LBP. The investigators selected studies which used the biologic interventions of platelet-rich plasma (PRP) and/or mesenchymal stem cells (MSC).

A total of 10 observational studies and 2 randomized clinical trials met the review inclusion criteria.

For PRP, 1 randomized trial comprising 58 participants found that significantly more recipients of the intervention were satisfied or would undergo the same treatment (odds ratio [OR], 5.8; 95% CI, 1.2-37.5; P =.01). However, by 8 weeks, there was no significant group difference between the PRP or control cohorts. There were 4 observational studies which evaluated PRP efficacy. The aggregate analysis of these data found that 54.8% of the 42 PRP recipients had >50% LBP relief at 6 months after treatment.

There was 1 randomized trial which used MSC that comprised 24 participants. There were no significant differences in LBP scores observed between active and sham treatment at 6 and 12 months. There were 5 observational studies which together reported >50% LBP relief among 53.5% of the 43 MSC recipients at 6 months.

In addition, there was 1 observational cohort study which combined PRP with MSC treatments. Among the 15 participants who receiving injection at up to 3 discs, 66.7% had less pain at 6 months and pain scores decreased from 5.6 to 3.6.

No study reported serious complications, however, there were case reports of discitis, highlighting the importance of safety concerns for these procedures. In the realm of safety, there was a lack of standardization surrounding the delivery of regenerative medicine services, making it difficult to assess the overall complication rates.

Overall, the study investigators reported these data were of very low quality due to small sample sizes, missing data, imprecision, and bias, among other reasons. The authors also reported some suspected confirmation bias on their part due to previous experience and knowledge of the procedure.

This review found that there may be an application for biologic therapies for discogenic LBP, however, with the very low-quality data currently available, it was difficult to justify its use in clinical practice. Additional, high-quality studies are needed.

Reference

Schneider BJ, Hunt C, Conger A, et al. The effectiveness of intradiscal biologic treatments for discogenic low back pain: a systematic review.Spine J. 2021;S1529-9430(21)00831-7. doi:10.1016/j.spinee.2021.07.015