Platelet Rich Plasma in the Disc Space from a Surgeon's Perspective

Injecting Platelet Rich Plasma (PRP) in the Epidural Space

As a board certified and fellowship trained spine surgeon, with 25 years of spine surgery experience, the question is why you would possibly do this?

the word Arachnoiditis with medical diagnosis paper in the backgroundAs a spine surgeon, I think placing Platlet Rich Plasma (PRP) into the epidural space is dangerous. If this material inadvertently goes into the thecal sac, I do believe there is a risk of producing arachnoiditis. 

  • Arachnoiditis is a condition of chronic inflammation and permanent damage to the nerve roots which results in constant severe chronic pain. There is no treatment for arachnoiditis. 

Injecting steroids into the epidural space has some physiologic rationale. The steroids are very anti-inflammatory and can decrease the inflammation in the spinal canal and the exiting nerve roots. This can decrease swelling and result in a patient feeling less back and leg pain. Injecting steroids in the epidural space is standard of care. Injecting PRP in the epidural space has no physiologic rationale and absolutely no data to support its use. 

If you combine the fact there is no clinical data or physiologic rationale to putting this material in the epidural space along with the potential downside of producing arachnoiditis, I personally would never place PRP in the epidural space.