title: Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain.
abstract: BACKGROUND
  Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge.
  
  
  OBJECTIVE
  The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain.
  
  
  METHODS
  The study was designed as an observational retrospective pilot study. Eighty-six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012.
  
  
  METHODS
  One intradiscal, one intra-articular facet, and one transforaminal epidural injection of PRGF-Endoret under fluoroscopic guidance-control were carried out in 86 patients with chronic LBP in the operating theater setting.
  
  
  METHODS
  Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow-up time points on pain reduction after treatment.
  
  
  RESULTS
  Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF-Endoret injections showed a statistically significant drop from 8.4 ± 1.1 before the treatment to 4 ± 2.6, 1.7 ± 2.3, and 0.8 ± 1.7 at 1, 3, and 6 months after the treatment, respectively, with respect to all the time evaluations (P< 0.0001) except for the pain reduction between the 3rdand 6thmonth whose signification was lower (P< 0.05). The analysis of the VAS over time showed that at the end point of the study (6 months), 91% of patients showed an excellent score, 8.1% showed a moderate improvement, and 1.2% were in the inefficient score.
  
  
  CONCLUSIONS
  Fluoroscopy-guided infiltrations of intervertebral discs and facet joints with PRGF in patients with chronic LBP resulted in significant pain reduction assessed by VAS.
authors.affiliation: Barcelona Traumatology Institute, Mataró, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Kirchner
authors.affiliation: Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain; BTI-Biotechnology Institute, Vitoria, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Anitua
keywords: Chronic low back pain; fibrin matrix; plasma rich in growth factors; platelet-rich plasma; visual analog scale