How are orthobiologics transforming the back pain treatment algorithm? In this episode of BackTable MSK, host Jacob Fleming is joined by Dr. Guilherme Ferreira Dos Santos to discuss the management of lumbar pain and the role of platelet-rich plasma (PRP) injections. Dr. Santos is trained in Physical Medicine & Rehabilitation as well as Interventional Pain Medicine, and currently practices at the Hospital Clinic of Barcelona.

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SYNPOSIS

Dr. Santos gives an overview of discogenic pain. Each patient case is unique, as pain can be caused by single level or multilevel disease, pure disc disease, or additional facet joint disease. Additionally, discogenic pain can affect young, active patients and typically worsens with spinal flexion. They discuss the Pfirrmann system for intervertebral disc degeneration, medial branch blocks to identify posterior column pain, the risk of disc degeneration after discography, and the rise of orthobiologic treatments such as intradiscal and facet joint PRP injections. Dr. Santos highlights important steps for PRP preparation and techniques for injection. He also gives advice for counseling patients about the timeline to pain relief, longevity of treatment effects, and options for refractory pain. Finally, Dr. Santos encourages the audience to stay tuned for the upcoming RESPINE multicenter trial results.

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TIMESTAMPS

00:00 - Introduction

02:18 - Dr. Santos’ Multicultural Experiences

08:58 - Challenges in Diagnosing and Treating Discogenic Pain

20:26 - Role of Intradiscal and Facet Joint PRP Injections

30:16 - PRP Preparation and Dosing

34:52 - Technical Aspects of Disc Treatments

42:54 - Patient Counseling

56:58 - Future Directions in Regenerative Medicine

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RESOURCES

RESPINE Trial:

https://ecrin.org/clinical-trials/respine

Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study (Tuakli-Wosornu, 2016):

https://pubmed.ncbi.nlm.nih.gov/26314234/

Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain (Lutz, 2022):

https://pubmed.ncbi.nlm.nih.gov/35344055/