Epidural Administration of Biologics

Epidural injections have been utilized in managing chronic low back pain since 1901 with descriptions of caudal epidural injections. Since then, numerous developments have occurred. Epidural injections are performed for various disorders, specifically resulting in radicular pain. Epidural injections have been shown to be effective in radicular pain secondary to disc herniation, post-surgery syndrome, and spinal stenosis. However, they also have been shown to be effective in discogenic pain with similar evidence as in those conditions with radicular pain. Epidural administration of local anesthetic and steroids have been extensively discussed in randomized controlled trials (RCTs), systematic reviews, meta-analysis, and guidelines. However, epidural injections are only one of the invasive procedures in managing chronic spinal pain, apart from numerous conservative therapies including extensive drug therapy and, finally, a multitude of surgical interventions. In a significant proportion of patients, none of these modalities may provide satisfactory or long-term relief. Consequently, with emergence of advances in regenerative medicine with injection of biologics into various structures in the spine, epidural injection of biologics have been reported. This chapter describes the role of epidural administration of PRP and bone marrow aspirate.