ANNULAR TEAR TREATMENT WITH ALB-PRF

AUTHOR: ROBERT TALAC, MD, PhD

TL;DR

Inter-vertebral disc represents an essential part of the human spine. Substantial body of scientific evidence suggest that structural alteration of the disc whether due to the injury or aging is a root cause of low back pain and loss of spine function. We present novel regenerative strategy to fix this problem.

WHAT IS ANNULAR TEAR?

Inter-vertebral disc represents an essential part of the human spine. It consists of two parts: a.) The inner, gel-like core also known as nucleus pulposus; and b.) Outer lamelar parts also known as Annulus fibrosus. Substantial body of scientific evidence suggest that annular tear – structural alteration of the disc (Fig.1) whether due to the injury or aging is a root cause of low back pain and loss of spine function.

Fig.1 Annular tear of lumbar inter-vertebral disc. A. MRI image of the lumbar inter-vertebral disc showing high intensity zone (HIZ – Arrow) consistent with the damage to outer layer of the disc. B. CT annulogram – The image shows leak of contrast agent out of confine of the disc confirming damage to the annulus fibrosus of the disc.

WHY IS ANNULAR TEAR TREATMENT IMPORTANT?

The structural damage of the disc is considered a root cause of subsequent problems with the disc that ultimately leads to chronic back pain and possibly other functional musculoskeletal problems. Despite extensive research in this area, the structural damage of the disc and subsequently herniation or degeneration remain a significant clinical problem. There are 2 main reasons why annular tears represent such big clinical problem. First, current non-operative strategies are non-specific mostly focused on alleviation of pain and other symptoms. They do nothing to heal the disc damage or prevent further deterioration of the disc. The structural damage to the annulus fibrosus is left to its natural progression. Surgical treatment is mostly reserved for mechanical consequences of disc damage, specifically removal of herniated fragments compressing the adjacent nerve roots or enlarging the space for neural structures inside of the spinal canal. Usually, surgery is not indicated for the annular tear itself and most spine surgeons refer patients with annular tear to physical therapy or pain management. The end-result is clear. All traditional strategies fails to address the cause of disc deterioration.

Given the high prevalence of low back pain and less than desirable outcomes of its treatment it is not surprising that physician are looking for novel treatment strategies attempting to repair or replace disc tissue. However, development of true disc repair strategies was relatively slow due to complexity of the disc tissue and challenging physical, mechanical and functional demands of the disc environment.

NOVEL RESTORATIVE STRATEGY FOR ANNULAR TEAR TREATMENT USING ALB-PRF.

Most recently, we have used blood-derived, Platelet Rich Fibrin biomatrix (Alb-PRF) for treatment of annular tears similar to one shown on Fig.1.

Fig.2 Blood derived Platelet-Rich Fibrin derived from patient blood.

Alb-PRF is novel regenerative bio-matrix derived from patient’s blood (Fig.2). Alb-PRF is injectable so no surgical intervention is necessary. It is 100% natural and chemical free eliminating any concerns about allergic reaction or adverse immune reaction. If you are interested to learn more about Alb-PRF click here MEET THE ALB-PRF. Our early experience has shown that Alb-PRF can be injected into affected disc and seal the tear (Fig. 3).

Fig.3 Annular tear can be treated via small injection – see arrow. No surgery needed, no hospitalization or lengthy recovery needed.

The patients also reported prompt resolution of their symptoms. It is conceivable that prompt resolution of pain is related to sealing the disc space preventing nucleus pulposus tissue from irritation of spinal nerve roots. None of the patients required surgical intervention and were able to resume normal activities of daily living . Alb-PRF is almost exactly mimicking and supplementing the body natural response to the injury. It is conceivable that by maintaining the same relative proportion of cells, growth factors and natural fibrin scaffold that naturally aggregate in the site of injury, the Alb-PRF leads to repair and regeneration of annulus fibrosus.