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Platelet-rich plasma in the management of chronic low back pain


Low back pain (LBP) is now considered the first cause of disability in the world and should be a priority for future research on prevention and therapy. Inter-vertebrate disc dioxide (IVD) is an important pathogenesis of LBP. Platema-rich plasma (PRP) is an autologous blood concentrate which contains a natural concentration of automatic growth factors and cytokines and is widely used in the clinical setting for tissue regeneration and repair. PRP has great potential to stimulate cell proliferation and metabolic activity in vitro IVD cells. Several animal studies have shown that the PRP injection is an effective degradation IVDs for restoring structural changes (IVD height) and improving matrix integrity of degraded IVDs as estimated by magnetic resonance imaging (MRI) and histology . The results of this original research have shown that there is considerable potential for PRP to have significant biological effects for tissue repair to combat IVD degradation. Clinical studies were reviewed to assess the effects of PRP injection into degraded machines vehicles for patients with discogenic LBP. Although there was only one random randomized trial twice, all studies reported that PRP was safe and effective for reducing back pain. While the clinical evidence relating to IVD tissue repair by PRP treatment is currently in place, there is a great possibility that the implementation of PRP to treat decay disk diseases could lead to fiscal therapy. Further large-scale studies may be required to confirm the clinical evidence of PRP for the treatment of discogenic LBP.

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Epidemiology of low back pain (LBP)

LBP, a very common symptom in populations of all ages from children to older people, is heavily associated with personal, social and economic burdens around the world. In 2012, a systematic review of the global prevalence of LBP reported that LBP activity point prevalence was estimated to be  12%, while the prevalence of 1 month was 23% . LBP prevalence was higher in women than among men in all age group and were quite high during adolescence. An international pain survey of the Health Behavior in School-aged Children data: a national WHO (HBSC) collaborative survey showed that 37.0% of adolescents reported LBP monthly or more frequently. Some epidemiological studies showed that the prevalence of LBP was highest during the middle ages. Therefore, the LBP has a major economic impact.

Recently, in 2015, the Global Burden of Disease (GBD) reported that the global point prevalence of LBP was 7.3% (540 million people worldwide), and that LBP is now regarded as the first cause of disability across the world. deep.  The authors of the 2015 GDB suggest that LBP should be a priority for future research on prevention and therapy.

Traditionally, approximately 85% of patients, known as “non-specific LBP”, have been of the opinion that a clear LBP cause has been made in recent decades. However, recent epidemiological, radiological and clinical studies showed cumulative evidence that a specific niciceptive initiative of LBP can be identified through a comprehensive diagnosis including radiological examinations, interventions and physicals by spinal and / or orthopedic specialists.

Epidemiological studies of large population samples have recently shown that LBP is significantly associated with lumbar disc generation. A cross-sectional study of young people aged 13 to 20 showed a stronger correlation between disc and LBP disconnection. Than in the adult population also reported that younger patients have a higher tendency to have a discogenic origin of LBP.

Intervertebral disc degeneration (IVD)

It is known that rupture (including tears and / or split formation) within IVD tissue comes from the progress of IVD degeneration. Due to a lack of blood supply, IVD tissues have little potential for self-repair. A previous report showed that an internal disk interference was estimated at 39% of the LB chronic patients, on the other hand, of the chronic LB tomography, on the other hand, the tears annulus fibrosus (AF) in the AF area are called high tears. stringent zones (HIZs) and are regarded as high-intensity signals of T2-weighted magnetic resonance (MR). Previous reports indicated that HIZs were identified in 28% –59% of cases among symptomatic LBP patients. reported that vascularized granulation tissue from the NP was discovered to the outer AF along the atmosphere, where immunological immunization fibers were identified, in the HIZ area collected from lumbar surgery. In addition, reported that TNF-α and CD68-positive cells were detected in the HIZ area, suggesting that HIZ may be a specific sign for painful IVD painful reactions. Have shown that nerve fibers (9.5 protein gene product – reactive immunity) in scar tissues (extruded disc tissues) in the decomposition of annular punching disk model. The previous reports suggest that rupture disc disorders would not cause an inflammatory tissue reaction but nervous nerve growth around tissue scars associated with chronic pain of a discourse origin.

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