1. 2021;24;E649-E660Plasma Rich in Growth Factors (PRGF) in the Treatment of Cervical and Lumbar Back Pain: A Retrospective Observational Clinical Study
   Retrospective Study
   Eduardo Anitua, PhD, Sabino Padilla, PhD, Nicolas Kirchner-Bossi, PhD, Roberto Prado, PhD, Fernando Kirchner, MD, Isidro Milani, MD, and Alex Martinez, MD.

BACKGROUND: Plasma rich in growth factors (PRGF) is a leukocyte-free platelet-rich plasma (PRP) that is an effective biological approach to tissue repair and has been demonstrated to significantly improve multiple conditions, including low back pain and degenerative disc pathology.

OBJECTIVES: The objective of this retrospective study was to analyze the effectiveness of treating both cervical and lumbar spine pain with minimally invasive infiltrations of PRGF-Endoret.

STUDY DESIGN: Retrospective study design.

SETTING: Outpatient private practice facility.

METHODS: The effectiveness of PRGF has been assessed by patient-reported outcomes (PRO) through validated questionnaires, namely Numeric Rating Scale (NRS) for back pain, Spine Tango Core Outcome Measure Index (COMI) Questionnaire for lumbar and cervical pain, and OSWESTRY Disability Index questionnaire for lumbar pain cases. Score differences between pre- and post-treatment have also been assessed stratified for multiple sub-groups of patients based on the sector of the column treated, gender, and age.

RESULTS: This study includes 65 patients (18 with cervical pain and 47 with lumbar back pain). The average time of back pain evolution was 10 years. Patients received at least 2 PRGF infiltration series about one month apart. Each patient received intervertebral disc and epidural infiltrations, root infiltrations, in case of radicular injury, and intraarticular infiltrations, in case of osteoarthritis of the facet joints. Results show statistically significant (P < 0.05) improvements on all analyzed scores. Regarding the stratified analyses, 249 (99%) sub-groups showed an improvement in all tests (252 cases overall). From the 249 improving cases, 154 (62%) showed a statistically significant difference between the pre- and the post- treatment periods.

LIMITATIONS: This research is a retrospective study with a relatively small sample cohort. Only PRO have been assessed.

CONCLUSIONS: According to the results obtained in this study, and taking into account their limitations, PRGF infiltrations are an effective and minimally invasive biological strategy in the treatment of both cervical and lumbar pain, evaluated according to PRO.

KEY WORDS: Back pain, degenerative disc disease, growth factors, intervertebral disc degeneration, plasma rich in growth factors, platelet-rich plasma, regenerative medicine, tissue engineering