Table 4.

Clinical studies of PRP for LBP patients

Study	Study design	Number of patients	Diagnostic discography	Injection method	PRP preparation method	Characteristics of PRP	Volume of whole blood	Injection volume of PRP	Follow-up period	Outcome measure	Maximum improvement time point	Comment
Intradiscal injection
Akeda et al (2011)72	Prospective preliminary trial	6	Yes	Intradiscal	Buffy coat method	P-PRP releasate ACT: CaCl + 2 autoserum	200 mL	2 mL	6 M	VAS (7.1→1.8**) and RDQ (11→3.2**)	6 M
Bodor et al (2014)73	Case series	35	Yes	Intradiscal	Cascade Autologous Platelet System (ConMed Linvatec)	P-PRP ACT: no	9 mL	2 mL	2–10 M	NRS and ODI (positive response of 2/3 patients)	1 W–2 M
Navani and Hames (2015)74	Case series	6	Yes	Intradiscal	P-PRP system (EmCyte)	L-PRP ACT: no	60 mL	1.5–3 mL	24 W	VPS (50% decrease in 6 patients)	24 W
Levi et al (2016)75	Prospective trial	22	Partial	Intradiscal	Smartprep (Harvest)	L-PRP ACT: no	30 or 60 mL	1.5 mL	6 M	47% patients (both VAS 50% and ODI 30% improvement)	6 M	PRP injection just after 0.6 mL of contrast, 0.4 mL of gentamicin, and 0.5 mL of lidocaine
Tuakli-Wosornu et al (2016)77 Monfett et al (2016)78	Double-blind randomized controlled trial	36 treatments and 22 controls	Yes	Intradiscal	Smartprep (Harvest)	L-PRP ACT: no	30 mL	1–2 mL	8 W (RCT)	FRI (control 44–PRP 38*), NRS, SF-36, and modified NASS Outcome Questionnaire	1–2 years	PRP injection just after 1–2 mL injection of contrast
Akeda et al (2017)61	Prospective trial	14	Yes	Intradiscal	Buffy coat method	P-PRP releasate ACT: CaCl + auto 2 serum	200 mL	2 mL	10 M	VAS (7.5→3.1**) and RDQ (12.6→5.1**) T2-value: no change	1 M	Discography on different days from PRP injection
Lutz (2017)90	Single case report	1	Yes	Intradiscal	Arteriocyte (Magellan)	L-PRP ACT: N/D	N/D	1.5 mL	12 M	Improvement T2 nuclear signal intensity↑, type I Modic changes↓	N/A	PRP injection just after injection of contrast
Non-intradiscal injections (facet, epidural, and intramuscular)
Aufiero et al (2015)79	Case report	5	N/A	Intraarticular (facet)	N/D	P-PRP ACT: no	N/D	Multiple injection	6–12 M	VAS	N/A
Kirchner and Anitua (2016)80,81	Observational retrospective pilot study	86	Yes	Intradiscal and intraarticular	PRGF system IV (BTI-Biotechnology Institute, Vitoria, Álava, Spain)	PRGF ACT: CaC 2 l	9 mL	4 mL (disc) and 2 mL (facet)	6 M	VAS (8.4→0.8**) 91% excellent 8.1% moderate	6 M
Wu et al (2016)82	Prospective study	19	N/A	Intraarticular (facet)	Centrifuge 2 times soft spin	N/D	5–10 mL	0.5 mL	3 M	VAS (7.05→2.63, P<0.05) RDQ (P<0.05) ODI (54.3→26.3, P<0.05)	3 M
Bhatia and Chopra (2016)84	Pilot study	10	N/A	Epidural	Blood bank No detail	N/D	100 mL	5 mL	3 M	VAS, MODQ index, and SLRT (most of the patients improved in all evaluations)	3 M
Hussein and Hussein (2016)85	Prospective trial	104	N/A	Intramuscular (weekly injection for 6 weeks)	PRP method	L-PRP ACT: CaC 2 l	50 mL	2.5 mL	2 years	NRS (8.81→3.5**) and ODI (36.7→14.7**)	12–18 M
Wu et al (2017)83	Randomized controlled study	21 (PRP) 23 (betamethasone)	N/A	Intraarticular (facet)	Centrifuge 2 times soft spin	N/D	5–10 mL	0.5 mL	6 M	PRP> betamethasone (VAS, RDQ, and ODI)	6 M
Cameron and Thielen (2017)86	Prospective trial	50	N/A	Circumferential manner into posterior spine area	N/D	N/D	N/D	N/D	5 years	VAS (–77% improvement) and ODI	No description	LBP caused by spinal disc herniation
Comella et al (2017)87	Prospective trial	15	No	Intradiscal	N/D	PRP mixed with stromal vascular fraction	N/D	1 mL	6 M (safety 12 M)	VAS (5.6→3.6**), PPI (2.6→1.8*), BDI, ODI, SM-MPQ, SF-12, and DPQ	6 M

Note:

^*P<0.05 and

^**P<0.01.

Abbreviations: ACT, activation; BDI, Beck Depression Inventory; DPQ, Dallas Pain Questionnaire; FRI, Functional Rating Index; LBP, low back pain; L-PRP, leukocyte- and platelet-rich plasma; M, months; MODQ, Modified Oswestry Disability Questionnaire; N/A, not applicable; N/D, no description; NRS, Numeric Rating Scale; ODI, Oswestry Disability Index; PPI, present pain intensity; P-PRP, Leukocyte-poor PRP; PRP, platelet-rich plasma; RDQ, Roland-Morris Disability Questionnaire; SF, Short Form; SF-MPQ, Short-form McGill Pain Questionnaire; SLRT, Straight Leg Raising Test; VPS, verbal pain scale; W, weeks.