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Disc Injections

LUMBAR OR THORACIC PLATELET-RICH PLASMA INTRA-DISCAL INJECTION THERAPY (IDIT)

What is Intra-Discal Injection Therapy (IDIT)?

Intra-discal injection therapy is the injection of medication inside the vertebral disc.

 

What is the purpose of intra-discal injection therapy?

To relieve pain and increase function.

There are two “medications” that can be injected into the center part of the disc: platelet-rich plasma (PRP) or stem cell therapy. Both come from the patient’s own body and are forms of regenerative medicine. PRP stimulates healing and stem cells transplanted from the patient’s own body add to the naturally-occurring cells inside the disc that are responsible for naturally repairing the disc wall. Both include multiple growth factors.

 

Why Does PRP Work?

Human platelets are naturally extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments and tendons stimulates a natural repair process. But in order to benefit from these natural healing proteins, the platelets must first be concentrated. In other words, platelet-rich plasma recreates and stimulates the body’s natural healing process.

 

Are you a Candidate?

Anyone who has back and leg pain caused by degeneration of the inter-vertebral disc, especially if an epidural steroid injection has failed to help, is likely eligible.

 

How is the Procedure Performed?

The patient lies face down on the procedure table. X-ray equipment (fluoroscopy) is always used. The site to be injected is numbed with local anesthetic (Novocain) and a needle is directed to the target area. The physician will tell you when he plans to start the injection. Contrast (x-ray dye) mixed with the antibiotic is injected into the disc. Only enough is injected to assure the needle is in the correct place.

Platelet-rich plasma (PRP) is then injected slowly into the disc. This may or may not be painful depending on the condition of the disc. The medication is injected into all the abnormal discs on MRI, and usually in the first normal disc above to make sure it is truly normal. Usually, a medication mixture is injected into all the discs that are abnormal on the MRI. The disc above the abnormal discs is tested to be sure it is really normal.

I usually try to get some information as to which discs are painful when the first intra-discal injection therapy treatment takes place. For all other treatments, you will be able to get as much sedation as necessary.

 

Will the Procedure be Painful?

The first time the procedure is done, there is usually some pain when the medication is injected, and you will be asked if it reproduces your usual pain and if the pain is mild, moderate or severe. Pain medication will be administered intravenously if necessary. All additional treatments will be done without asking about the pain, and you can have as much sedation as is necessary and safe. Pain occurs when the skin and underlying tissues are numbed. The smallest sized needle that will accomplish the procedure is always used. IV sedation is routinely used. Typically, there is some pain over the first few days.

 

What are the Risks and Side Effects?

Infection is one of the more serious side effects. If an infection of the disc occurs, you will usually be very sick and require antibiotics. Hospitalization and IV antibiotics may be necessary. You will be given IV antibiotics before the procedure; antibiotics are mixed with the contrast dye, and the procedure is done under a full surgical scrub and drape to minimize the risk of infection.

The most serious side effects from intravenous sedation are sudden death, brain damage from low blood pressure, or allergy from the medication. These are extremely rare and have never happened in my practice. A nurse will be monitoring your blood pressure, blood oxygen level, and heart rate. If necessary, oxygen will be administered through a tube inserted in your nose.

You may have an allergic reaction to any of the medications used. If you have a known allergy to any medication, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place.

 

How Long Does it Take for the Procedure to Work?

Although some patients get some measure of relief earlier, the majority of patients get most of their relief at about two months.

 

What Restrictions Will I Have on the Day of the Procedure?

If you have sedation, you will not be allowed to drive, operate machinery, or make legal decisions until the next day. You should not soak until the skin is healed. You may shower the same day. You should avoid any vigorous activity for several days.

CERVICAL PLATELET-RICH PLASMA INTRA-DISCAL INJECTION THERAPY

 

What is Platelet Rich Plasma Intra-Discal Injection Therapy?

Intra-discal injection therapy is the injection of medication inside the intervertebral disc. In this case, the “medication” is platelet-rich plasma (PRP) taken from your blood at the time of the procedure.

 

What is the Purpose of Intra-Discal Injection Therapy?

To relieve pain and increase function.

 

Why Does PRP Work?

Human platelets are naturally extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments and tendons stimulates a natural repair process. But in order to benefit from these natural healing proteins, the platelets must first be concentrated. In other words, PRP recreates and stimulates the body’s natural healing process.

 

 

What patients are candidates for intra-discal injection therapy?

Patients who have neck and arm pain caused by degeneration of the intervertebral disc.

 

How is the Procedure Performed?

Before the procedure, blood is drawn from one of the veins in your arm. This is then centrifuged to concentrate the platelets. The plasma with the concentrated platelets is called platelet-rich plasma (PRP). Everything left over is discarded, and the PRP is the “medication” that is injected into the disc.

The patient lies face up, rotated to the left on the procedure table. Cervical disc injections are always done from the right for safety reasons. X-ray equipment (fluoroscopy) is always used. Intravenous antibiotics and a full surgical prep and drape is done to prevent infection. The site to be injected is numbed with local anesthetic (Novocain) and a needle is directed to the target area. The physician will tell you when he plans to start the injection. Contrast (x-ray dye) mixed with an antibiotic is injected. After it is clear that the needle is in the correct place, the PRP is injected. The needle may be repositioned into the disc wall as well.

 

Will the Procedure be Painful?

There is discomfort associated with this procedure. You can have as much sedation as is necessary and safe. Pain occurs when the skin and underlying tissues are numbed. The smallest sized needle that will accomplish the procedure is always used. IV sedation is routinely used. Typically, there is some pain over the next few days.

 

What are the risks and side effects?

The use of PRP injections into the disc for pain relief has been studied in at least two published papers, and there were no complications reported. Still, this is not a common procedure yet, although it is done frequently in hundreds of clinics throughout the United States.

Infection is one of the more serious side effects. If an infection of the disc occurs, you will usually be very sick and require antibiotics. Hospitalization and IV antibiotics may be necessary. You will be given IV antibiotics before the procedure. Antibiotics are mixed with the contrast dye, and the procedure is done under a full surgical scrub and drape to minimize the risk of infection.

Another possible complication would be a disc herniation when the pressure inside the disc is raised with the injection of the medication. Care is taken not to let that happen, and to date, it has not happened in our clinic.

The most serious side effects from intravenous sedation are sudden death, brain damage from low blood pressure, or allergy from the medication. These are extremely rare and have never happened in my practice. A nurse will be monitoring your blood pressure, blood oxygen level, and heart rate. If necessary, oxygen will be administered through a tube inserted in your nose.

You may have an allergic reaction to any of the medications used. If you have a known allergy to any medication, especially x-ray contrast die or local anesthetics, notify our staff before the procedure takes place.

 

How Long Does it Take for the Procedure to Work?

Although some patients get some measure of relief earlier, the majority of patients get most of their relief at about two months.

What Restrictions Will I Have on the Day of the Procedure?

If you have sedation, you will not be allowed to drive, operate machinery, or make legal decisions until the next day. You should not soak until the skin is healed. You may shower the same day. You should avoid any vigorous activity for several days.

 

 

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