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      Intradiscal administration of autologous platelet‐rich plasma in patients with Modic type 1 associated low back pain: A prospective pilot study

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          Abstract

          Background

          Various treatments for chronic low back pain (LBP) have been reported; among them, platelet‐rich plasma (PRP) as a regenerative medicine has attracted much attention. Although Modic type 1 change (MC1) is associated with LBP, no treatment has been established so far. In addition, no studies have administered PRP to intervertebral discs (IVDs) in patients with LBP, targeting MC1 only. Thus, the purpose of this study was to determine the safety and efficacy of PRP administration to the IVDs in patients with MC1 experiencing LBP.

          Methods

          PRP was injected intradiscally to 10 patients with MC1 experiencing LBP. Patients were followed prospectively for up to 24 weeks after primary administration. Physical condition, laboratory data, and lumbar x‐ray images were evaluated for safety assessment. Furthermore, to evaluate the effectiveness of PRP, patient‐reported outcomes were considered. In addition, changes in MC1 were assessed using magnetic resonance imaging (MRI).

          Results

          There were no adverse events in the laboratory data or lumbar X‐ray images after administration. The mean visual analog scale, which was 70.0 ± 13.3 before the treatment, significantly decreased 1 week after PRP administration and was 39.0 ± 28.8 at the last observation. Oswestry disability index and Roland Morris disability questionnaire scores promptly improved after treatment, and both improved significantly 24 weeks after PRP administration. Follow‐up MRI 24 weeks after treatment showed a significant decrease in the mean high‐signal intensity of fat‐suppressed T2‐weighted imaging from 10.1 to 7.90 mm 2 compared with that before PRP administration.

          Conclusions

          The safety and efficacy of PRP administration to the IVDs of patients with MC1 experiencing LBP were identified. Post‐treatment MRI suggested improvement in inflammation, speculating that PRP suppressed inflammation and consequently relieved the patient's symptoms. Despite the small number of patients, this treatment is promising for patients with MC1 experiencing LBP. The study protocol has been reviewed and approved by the Certified Committee for Regenerative Medicine and the Japanese Ministry of Health, Labor and Welfare (Japan Registry of Clinical Trials [jRCT] No. jRCTb042210159).

          Abstract

          This is the first prospective study evaluating the safety and efficacy of platelet‐rich plasma (PRP) administration to the intervertebral discs of patients with Modic type 1 change (MC1) experiencing low back pain. PRP treatment is promising for patients with MC1.

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          Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

          Theo Vos, Christine Allen, Megha Arora … (2017)
          Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Funding Bill & Melinda Gates Foundation.
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            What low back pain is and why we need to pay attention

            Paulo Ferreira, Manuela Ferreira, Peter Croft … (2018)
            Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.
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              A systematic review of the global prevalence of low back pain.

              Damian Hoy, Christopher Bain, Gail Williams … (2012)
              To perform a systematic review of the global prevalence of low back pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence. We conducted a new systematic review of the global prevalence of low back pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review. Low back pain was shown to be a major problem throughout the world, with the highest prevalence among female individuals and those aged 40-80 years. After adjusting for methodologic variation, the mean ± SEM point prevalence was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%. As the population ages, the global number of individuals with low back pain is likely to increase substantially over the coming decades. Investigators are encouraged to adopt recent recommendations for a standard definition of low back pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies. Copyright © 2012 by the American College of Rheumatology.
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                Author and article information

                Contributors
                Nobuyuki Fujita:
                ORCID: https://orcid.org/0000-0001-8658-2088
                nfujita2007@gmail.com
                Journal
                Journal ID (nlm-ta): JOR Spine
                Journal ID (iso-abbrev): JOR Spine
                Journal ID (doi): 10.1002/(ISSN)2572-1143
                Journal ID (publisher-id): JSP2
                Title: JOR Spine
                Publisher: John Wiley & Sons, Inc. (Hoboken, USA )
                ISSN (Electronic): 2572-1143
                Publication date (Electronic): 18 March 2024
                Publication date Collection: March 2024
                Volume: 7
                Issue: 1 ( doiID: 10.1002/jsp2.v7.1 )
                Electronic Location Identifier: e1320
                Affiliations
                [ 1 ] Department of Orthopaedic Surgery, School of Medicine Fujita Health University Toyoake Aichi Japan
                [ 2 ] Department of Spine and Spinal Cord Surgery, School of Medicine Fujita Health University Toyoake Aichi Japan
                [ 3 ] Department of Clinical Affairs Zimmer Biomet G.K. Tokyo Japan
                [ 4 ] Canon Medical Systems Corporation Otawara Tochigi Japan
                [ 5 ] Department of Diagnostic Radiology, School of Medicine Fujita Health University Toyoake Aichi Japan
                [ 6 ] Joint Research Laboratory of Advanced Medical Imaging, School of Medicine Fujita Health University Toyoake Aichi Japan
                Author notes
                [*] [* ] Correspondence

                Nobuyuki Fujita, Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1‐98 Dengakugakubo, Kutsukake‐cho, Toyoake, Aichi 470‐1192, Japan.

                Email: nfujita2007@ 123456gmail.com

                Author information
                https://orcid.org/0000-0001-8658-2088
                Article
                Publisher ID: JSP21320
                DOI: 10.1002/jsp2.1320
                PMC ID: 10945308
                PubMed ID: 38500785
                SO-VID: 30c17c6a-4377-416f-a784-fa9dd44e8454
                Copyright © © 2024 The Authors. JOR Spine published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 06 January 2024
                Date received : 27 July 2023
                Date accepted : 25 February 2024
                Page count
                Figures: 5, Tables: 6, Pages: 11, Words: 7591
                Funding
                Funded by: Zimmer Biomet
                Award ID: IRA2021‐31B
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date March 2024
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.9 mode:remove_FC converted:18.03.2024

                Keywords: intervertebral disc (ivds),low back pain (lbp),modic type 1change (mc1),platelet‐rich plasma (prp),regenerative medicines
                Data availability:
                Keywords: intervertebral disc (ivds), low back pain (lbp), modic type 1change (mc1), platelet‐rich plasma (prp), regenerative medicines

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