1666. A Novel Approach for Lumbar Discogenic Pain: Orthobiologic Delivery Under Fluoroscopic Guidance to Address the Functional Spinal Unit
Authors * Denotes Presenting Author
  1. Melissa Barber; Helfgott Research Institute, National University of Natural Medicine; RestorePDX
  2. Terrance Manning; Helfgott Research Institute, National University of Natural Medicine; RestorePDX
  3. Katarzyna Iwan; RestorePDX
  4. Rahul Desai *; RestorePDX
Lumbar discogenic pain can be difficult to treat and is a common cause of disability with a high socioeconomic burden. Therapeutic options spanning from conservative management to invasive procedures yield variable outcomes and usually fail to deliver durable benefit or modify the disease course (1). Orthobiologics hold promise as a less invasive and less costly treatment strategy compared to surgery and have the potential for favorable results. To date, intradiscal orthobiologic injection treatments have mostly included platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), with or without image guidance, delivered to one target area (2). Use of other injectates including lipoaspirate and combined injectate products delivered to a functional spinal unit (FSU) or osteoligamentous complex, under image guidance, may offer additional therapeutic benefit. Therefore, our objective is to describe a novel therapeutic approach to lumbar discogenic pain by targeting the FSU with an autologous combination product under fluoroscopy guidance.

Materials and Methods:
A retrospective case series was completed on cases in which multiple autologous orthobiologics (i.e., BMAC, lipoaspirate, platelet lysate, and PRP) were delivered to the FSU under fluoroscopy guidance to treat lumbar discogenic pain. The FSU included epidural, zygapophyseal joints, iliolumbar and sacroiliac ligaments, and intradiscal areas. Preparation of the injectates, and fluoroscopy methods, will be described. Case outcomes will be summarized based on abstracted data from patient records including available imaging data and patient reported outcomes measures.

A combination orthobiologic product injected into the FSU under fluoroscopy guidance appears to be safe and may be associated with clinically meaningful improvements in patients with lumbar discogenic pain, as demonstrated by changes in magnetic resonance imaging, the numeric pain rating scale, and Oswestry Disability Index.

A combination orthobiologic injectate product delivered to the FSU with fluoroscopy guidance appears to be a promising therapy for lumbar discogenic pain. This therapy may have the potential to confer local tissue healing and provide long-term relief, warranting prospective clinical trials.