PM&R News   • February, 2019

Regenerative medicine continues to be the hot topic for musculoskeletal pain and new treatments continue to evolve. Data and research on stem cells and PRP continue to be limited to small case control trials with very few higher level, long term studies existing. This study aimed to perform a systematic review and metaanalysis to provide higher level evidence and guidelines for the treatment of low back pain with regenerative medicine. In all, 21 injection studies met guidelines for inclusion, including studies for lumbar disc injections, epidural injections, facet joint injections and sacroiliac joint injections.

First let’s review the levels of evidence on a I-VII scale. Level I is the highest level down to Level V that is the lowest evidence. Level I typically consists of a systematic review of relevant randomized controlled trials, level II is randomized controlled trials, level III is controlled trials without randomization, level IV are case control studies, and level V is descriptive studies of systematic reviews.

Now back to the study! The highest level of evidence was seen with lumbar disc injections of PRP and stem cells which rose to a level III. Only one study existed for epidural injections and it was considered level III. Lumbar facet joint injections/sacroiliac joint injections demonstrated level IV evidence. Check out the tables in the individual studies for simplified breakdown of each study with results. However, many of the studies have promising results which can lead to a paradigm shift in back pain. Moving from steroid injections with all of their side effects to stem cells or PRP with much less side effects.