Intradiscal Injections of Biologics

Chronic spinal pain is related to enormous and increasing socioeconomic burden on humanity across the globe. Numerous resources are utilized in managing chronic spinal pain with ever growing number of modalities leading to the high cost of interventions and often negative health policy implications. The intervertebral discs are one of the common pain generators in the spine, followed by facet joints and sacroiliac joints. It has been shown that discogenic low back pain with or without internal disc derangement is estimated to affect between 16.9 and 39% of chronic low back pain sufferers without radicular symptoms, whereas in the chronic cervical spine discogenic pain, the prevalence has been shown to be 16–53%. The pain emanating from pathologic changes within the disc itself without disc herniation is common. Despite numerous advances, diagnosis based on history, physical examination, and radiologic imaging has low sensitivity and specificity in determining whether or not the disc is a primary source of spinal pain. Among the various modalities of treatments available in managing discogenic pain, apart from traditional therapies, including medicinal rehabilitative, interventional and surgical modalities, intradiscal injections of biologics, platelet-rich plasma (PRP), and bone marrow aspirate stem cell concentrate (BMAC) have been gaining popularity in recent years. Thus, evidence continues to emerge with increase in publications in both basic and clinical science leading to randomized controlled trials (RCTs) and systematic reviews.