Prolotherapy for Lumbar Segmental Instability Associated with Degenerative Disc Disease

Prolotherapy for Lumbar Segmental Instability Associated with Degenerative Disc Disease

Abstract

Prolotherapy is an injection-based therapy that may be used in the management of chronic low back pain. In principle, injection solutions are formulated to produce an inflammatory response, which in turn promotes ligamentous and tendinous regeneration.

This case study series offers some ideas as to how Prolotherapy might be advantageous in the management of discogenic low back pain through improving vertebral segmental stability.

When the disc is of normal height, the ligaments that hold the spine together remain at normal length. As the disc height decreases as in degenerative disc disease, the vertebrae move closer together. The resultant loss of spinal ligament tension may allow vertebral segmental instability, leading to chronic pain.

Materials & Methods: The study analysed twenty-one male & female patients aged 35 to 73 years with chronic low back pain and MRI-confirmed low lumbar DDD (some with multi-level disease). They underwent 3 sets of fluoroscopically-guided Prolotherapy injections 1-3 weeks apart. Oswestry scores were analysed pre-Prolotherapy, at 3 months and at 1 year. All Oswestry scores were recorded on 14 patients, with the remainder only having pre and 1 year follow-up scores reported.

Results: Pre-Prolotherapy Oswestry scores ranged in all patients from 12 to 44. 12 patients reported ADL or functional improvement scores of 80% or greater. 3 patients reported ADL or functional improvement scores of 70% at 1 year follow up. 3 patients also reported complete resolution of LBP and 100% ADL improvement at one-year follow-up with one of these patients becoming symptom-free at 3 months with results maintained at one-year follow-up. On patients for whom 3-month follow-up data was available, there was typically further improvement on ADLs and pain reduction on one-year follow-up. 3 patients reported no ADL or pain reduction benefit at all from the Prolotherapy with one of these patients actually reporting worse LBP and ADL scores at both 3 month and one-year post Prolotherapy. An inverse pattern of reduced pain scores in relation to improved ADL function was noted.

Conclusions: These findings are consistent with the conclusions of other studies, in that Prolotherapy, in conjunction with rehabilitation would appear to be an effective part of the management pathway for discogenic low back pain associated with degenerative disc disease of the lumbar spine.

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