Intradiscal pain (confirmed through provocative discography with manometry) is probably the most difficult type of chronic low back pain to treat. Unfortunately, it is a common cause of low back pain, especially before age 65.
For a long time, arthrodesis surgery (i.e. lumbar spinal fusion) was the only treatment available.
Physiatrists at the Institut de Physiatrie were the first in Canada to offer percutaneous treatments for this problem.
The first two treatments that started in the late 1990s were intradiscal electrothermal therapy (IDET: denervation of the posterior annulus fibrosis by threading a catheter into the disk under fluoroscopic guidance in order to heat and burn the pain receptors) as well as biacuplasty (radiofrequency annular ablation using two catheters).
Other intradiscal treatments, such as platelet-rich plasma (PRP) and intradiscal ozone injections, have since replaced intradiscal electrothermal therapy (IDET) and are offered at the Institut de Physiatrie du Québec.
These treatments are performed for disc pain due to annular tearing or a herniated disc. Provocative discography with manometry can be done first to confirm the diagnosis and the origin of the pain, but it is not always essential.
The specialist will discuss and choose the best treatment with the patient based on various criteria.
Initially used for treating peripheral joint injuries and tendinopathies, PRP is now part of the therapeutic arsenal for disc pain.
As intradiscal pain is generally secondary to an annular fissure, a platelet-rich plasma injection (with growth factors) has been used and studied to try to catalyse the fissure and regenerate the intervertebral disc. PRP also plays an important anti-inflammatory role. This treatment is chosen if the disc is not extensively degenerated.
Improvement begins approximately two months after the injection, peaks at around six months and may continue for a few more months.
Before the procedure, blood is taken from the patient.
The blood is then centrifuged to separate its components and obtain the plasma.
While the plasma is being prepared, the patient receives an intravenous saline solution containing antibiotics to lower the risk of infection.
The procedure is performed on one, maximum two, intervertebral discs.
With the patient lying on the stomach, the skin is disinfected and a local anesthetic is applied.
A needle is inserted under fluoroscopic guidance into the disc(s) requiring treatment.
After ensuring that the needle is properly positioned, the PRP is injected into the disc(s).
The patient will feel pain similar to that experienced during disc provocation (if that test was performed) or their normal level of pain.
A one-week leave of absence from work is recommended following the procedure. It is not necessary to wear a corset.
Increased pain may occur for a few weeks following the intradiscal PRP injection. Applying ice and taking an analgesic help to reduce pain.
Complications are essentially related to the injection, the anatomy involved and the substances injected. The risk of hemorrhaging is rare. Intravenous antibiotics significantly lower the risk of intradiscal infection.
PRP intradiscal injection is contraindicated during pregnancy an in people with an active infection. Report all allergies to medications to the physician. NSAIDs are contraindicated in the week preceding the procedure and for the two following weeks.