• Laxmaiah Manchikanti, Emilija Knezevic, Nebojsa Nick Knezevic, Alan D Kaye, Sairam Atluri, Mahendra R Sanapati, Vidyasagar Pampati, and Joshua A Hirsch.
• Pain Management Centers of America, Paducah, KY and Evansville, IN; Departments of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; LSU Health Science Center, New Orleans, LA.
• Pain Physician. 2024 Dec 1; 27 (10): E995E1032E995-E1032.

BackgroundRecent research underscores the potential of intradiscal biologics, such as mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), and alpha-2-macroglobulin, in promoting chondrogenesis within lumbar intervertebral discs as a treatment for discogenic low back pain. Studies indicate significant improvements in pain relief, physical function, and overall quality of life following these interventions.ObjectiveThis study aims to evaluate the effectiveness of intradiscal injections of MSCs and PRP in managing low back and lower extremity pain. A systematic review and meta-analysis were conducted to assess the outcomes of these treatments.Study DesignA systematic review and meta-analysis evaluating the efficacy of PRP and MSC injections for discogenic low back and lower extremity pain.Data SourcesThe review included literature from PubMed, Cochrane Library, the U.S. National Guideline Clearinghouse (NGC), prior systematic reviews, and reference lists, covering studies from 1966 to September 2024.Study SelectionRandomized controlled trials (RCTs), observational studies, and case reports focusing on biologic injections into the disc were included.Data Extraction And SynthesisData were extracted and assessed for methodological quality. Evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria and summarized based on best evidence synthesis principles on a 1-to-5 scale.ResultsThe analysis included 8 RCTs (4 evaluating PRP, 5 evaluating MSCs) and 8 observational studies (4 assessing PRP, 4 assessing MSCs) for managing chronic low back pain. Evidence quality was deemed fair (Level III) with limited certainty and moderate recommendation strength based on qualitative and quantitative analyses.LimitationsPaucity of high-quality studies.ConclusionThis systematic review and single-arm meta-analysis suggest that intradiscal injections of MSCs and PRP may be effective in managing discogenic low back pain, supported by Level III evidence.

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