title: Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease.
abstract: BACKGROUND
  Lumbar multifidus muscle dysfunction and chronic low back pain are strongly correlated. There is no consensus regarding treatment of chronic LBP. The effect of platelet leukocyte rich plasma (PLRP) injections on atrophied lumbar multifidus (LMF) muscle and chronic low back pain has never been studied before.
  
  
  METHODS
  One hundred fifteen patients with chronic non-specific LBP fulfilled the inclusion criteria. Patients were treated with weekly PLRP injections for six weeks and followed up for 24 months. Primary outcome measures included Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI). Secondary outcome measures included Patient Satisfaction Index (PSI), modified MacNab criteria, and lumbar MRI at 12 months follow-up.
  
  
  RESULTS
  One hundred and four patients completed the trial. There were no serious complications. NRS significantly improved gradually from a mean of 8.8 ± 8 pre-injection to 3.45 ± 2.9 by 12 months and ODI significantly improved gradually from a mean of 36.7 ± 3.9 to 14.6 ± 12.8 by 12 months (P < 0.005). After reaching maximum improvement between 12 and 18 months, all outcome measures remained stable till the end of the 24 months follow-up period with statistically insignificant changes (P > 0.05). 87.8% (65/74) of the satisfied patients showed increased cross-sectional area and decreased fatty degeneration of LMF muscle on MRI at 12 months follow-up.
  
  
  CONCLUSIONS
  PLRP injections into atrophied lumbar multifidus muscle represent a safe, effective method for relieving chronic low back pain and disability with long-term patient satisfaction and success rate of 71.2%. We recommend the use of the lumbar PLRP injections of LMF muscle to refine the inclusion criteria of lumbar fusion to avoid failed back syndrome.
authors.affiliation: Department of Orthopedics and Traumatology, Surgery New Hospital, Zagazig University Hospitals and Faculty of Medicine, Zagazig University 44519 Zagazig City, Sharkiah Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hussein
authors.affiliation: Department of Anesthesiology and ICU, Surgery New Hospital, Zagazig University Hospitals and Faculty of Medicine, Zagazig University 44519 Zagazig City, Sharkiah Egypt.
authors.forename: Tamer
authors.initials: T
authors.lastname: Hussein
keywords: Atrophied lumbar multifidus muscle; Chronic low back pain; PLRP; Paraspinal muscles