Regenerative Medicine: PRP, Stem Cells, and Biologics for Disc Degeneration

Degenerative disc disease (DDD) is a multifactorial, progressive condition and a leading cause of chronic low back pain worldwide. Conventional treatments—including pharmacologic therapy, physical rehabilitation, spinal fusion, and total disc replacement—primarily address symptoms and biomechanical consequences rather than the underlying biology of disc degeneration. Advances in regenerative medicine have shifted the therapeutic focus toward biologic restoration of disc structure and function. This chapter provides a comprehensive, evidence-based review of regenerative strategies for DDD, integrating cell-based therapies, biologic injectables, and motion-preserving structural technologies within a disease-stage framework. Cell-based approaches—including bone marrow–derived mesenchymal stem cells (BM-MSCs), adipose-derived and umbilical cord–derived MSCs, mesenchymal precursor cells (MPCs), and disc-derived progenitor cells—are examined with respect to biological rationale, immunomodulatory mechanisms, translational challenges, and clinical outcomes. Among these, MPCs and discogenic cells currently demonstrate the strongest randomized clinical evidence, with emerging data suggesting potential structural restoration in selected patients. Platelet-rich plasma (PRP) represents a minimally invasive biologic option that delivers concentrated growth factors to modulate inflammation and stimulate matrix synthesis, with encouraging symptomatic results in early-stage disease. As degeneration advances and structural integrity declines, biologic therapies alone may be insufficient. The chapter therefore explores nucleus pulposus replacement technologies, annulus fibrosus repair strategies, and total disc replacement within the broader treatment continuum. Although promising, regenerative therapies face limitations, including heterogeneous clinical trial designs, limited long-term durability data, regulatory complexity, and the need for improved patient selection. Continued high-quality research and integration of biologic and mechanical strategies will be essential to realizing the full potential of regenerative medicine in altering the course of degenerative disc disease.