Regenerative Therapy by Dr. Brian Siegel, MD

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TOBI Faculty Publish New Article on Platelet Rich Plasma Application in Spine:

Recently, The Orthobiologic Institute Faculty members Danielle Aufiero, Steven Sampson, Hunter Vincent, and Marko Bodor published an article in the Journal of Stem Cell Research, Review & Reports titled: Regenerative Injection Treatment in the Spine: Review and Case Series with Platelet Rich Plasma. The article provides a review of Prolotherapy applications in the spine, and as well as logic for clinical application of Platelet Rich Plasma for similar spine mediated. In addition, the article discusses the current literature on the use of PRP in the spine. Furthermore, the article presents a 5 patient case series involving the application of PRP in the cervical, thoracic, and lumbar spine.

Each of the 5 patients were selected on the basis of history, physical examination, lack of significant disc pathology on MRI including herniated discs, annular disc tears or more than a moderate degree of degenerative disc disease. In addition, patients must have failed other conservative treatment modalities. The PRP used satisfied the following criteria: Platelet count > 1,500,000; no leukocytes; no red blood cells; and non-activated by exogenous means.  Each of the patients received a series of 3 PRP injections to the facet joints, capsules, supraspinous and interspinous ligaments using fluoroscopic or ultrasound guidance to the affected areas.

The results revealed positive findings in each of the 5 patients. Case 1: 60% symptom improvement following 2nd injections, 100% improvement & return to sport at 6 months; Case 2: at least 30% symptom improvement following 1st injection, 60% improvement following the 2nd series, & 1/10 VAS scale at 9 months; Case 3: at least 40% symptom improvement following 2nd injections, 2/10 VAS scale & improvement in functional status at 12 months; Case 4: 70% symptom improvement& increased functional status following 3rd injections; Case 5: 65-70% symptom improvement and increased functional status at 6-month follow-up.  Patient reported reduced fear and anxiety over inciting events, improved sleep, and decreased pain medication use.

Although, the study was not randomized or blinded, and represents a small sample size, it illustrates the potentially viable application of PRP in the spine. The symptomatic relief, and positive safety profile exhibited in the case series warrants further investigation into PRP use in the spine. This paper represents one of the first case series on PRP use for spine mediated pain, and further collaboration and research is needed to validate its findings.

For more cutting edge research and up to date science in PRP and regenerative medicine, be sure to stay involved with The Orthobiologic Institute. Although the 2015 symposium just ended, we are looking forward to another year of great research and the 2016 symposium on the horizon!

Article link:

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Are stem cells the future of medicine? TOBI Faculty studies new strategy to tackle severe knee osteoarthritis

Via TOBI – Mikel Sanchez et al – Expert Opin Biol Ther (2016) A new strategy to tackle severe knee osteoarthritis Combination of intra-articular and intraosseous injections of Platelet Rich Plasma.

This recent review by Dr. Sanchez & his team at the BTI Biotechnology Institute in Vitoria, Spain address current controversies in treating knee osteoarthritis (OA) with Platelet Rich Plasma (PRP). The central thesis of this paper rests on the concept that subchondral bone pathology has been overlooked by the research community for many years as a potential target for OA treatment. Several emerging studies have shown how alterations in subchondral bone (by vascular or mechanical stress) can initiate the catabolic process of the articular cartilage and synovial membrane. Indeed, the articular cartilage may simply be the “victim” of catabolic cytokines originating in the synovium and subchondral tissues.

Standard methods to introduce PRP into the intraarticular tissues of the knee joint adequately exposes the articular cartilage and synovial membrane to the the anti-inflammatory effects of PRP-released cytokines, but the deeper cartilage layers and subchondral bone are not addressed. A dys-regulated TGF-1 signaling pathway is implicated in the conversion of normal subchondral bone marrow into fibrovascular tissue, and Sanchez et al hypothesize that PRP delivered intraosseously into the subchondral bone can have a pro-regulatory effect on this process, and they provide an extensive and well-cited biochemical rationale for this treatment in their review paper. The Sanchez group has studied the intraosseous infusion of PRP into the femoral condyle and tibial plateau subchondral bone using sedation and fluoroscopically guided trocars. They highlight some promising preliminary data on safety and efficacy for this procedure, and hypothesize that the combination of intrasseous PRP infusion followed by intraarticular PRP infusion over several weeks may provide the arthritic knee joint the best opportunity to resist ongoing catabolic degeneration, as well as clinical pain and dysfunction

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