Epidural Plasma Rich in Growth Factors for Degenerative Disc Disease: A Valuable Alternative to Conventional “Palliative Medicine”

It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible. Intervertebral disc disease (IDD) is a progressive, chronic, degenerative disease. Over time, the degeneration worsens and ultimately becomes irreversible. The pathogenesis of IDD involves a complex interplay of inflammatory, immunological, and pressure-related processes. Current treatments for IDD, proposed in most ′consensus protocols′ do not correspond to the pathophysiological process involved in the IDD, as these treatments are mainly focused on relieving pain (palliative pain medicine). Surgical techniques (including fusion, laminectomy, and discectomy), aim to stabilize the spine and/or decompress the spinal or the foraminal canal thus alleviating symptoms, but these techniques are not addressed to regarding the cause of the degeneration, and sometimes even accelerate the degeneration of the adjacent segments. Recently, biological therapies have been attracting more attention in the field of intervertebral disc repair and regeneration. Plasma rich in growth factors (PRGF) has the ability to repair and regenerate bone and condral tissue and has a remarkable neuroprotective and anti-inflammatory actions by modulating the immune response, reversing IDD and relieving the neuropathic pain. Growth factors have been associated with the initiation of a healing cascade that leads to cellular chemotaxis, angiogenesis, synthesis of collagen matrix, and cell proliferation. This paper briefly describes the current understanding of growth factors and our experience with PRGF injected by the epidural route