Discussion
lumbar HNP, HNP, pain
DEGENERATIVE DISC DISEASE, STERILE
Prolotherapy uses a method of inflammatory induction to recruit cytokines and growth factors, which later promote healing cascade. However, the rationale of using PRP is it contains high concentration of cytokines and growth factors which are released overtime [PRP usage has been studied in orthopedic spine surgery, mainly in treating degenerative disc disease. Prior to PRP usage, Becker’s RCT reported superior results of PRP to triamcinolone on LegVAS by using of Autologous Conditioned Serum (ACS), another type of orthobiologics, in treating HNP by multiple injections [Patients treated with PRP showed significant improvement in VAS, ODI, and other functional scores. PRP showed high potential in regeneration and healing via several mechanism such as inflammatory regulation pathway, cellular stimulation, and tissue regeneration pathway in both animal model and human [According to the meta-analysis about spontaneous disc resorption, the overall incidence is about 67% in conservative patients [We concurred with Zhen Xu et al.’s study on efficacy of PRP compared to betamethasone in treating lumbar HNP in term of pain score and functional score [Our research conducted RCT, with similar demographic data with single experience surgeon, represented an emerging substitute, PRP, in treating single-level HNP. The drawback for PRP is injection time which is within one hour after final product. PRP production protocol takes about 30 min for overall process. This protocol can be done in any hospital because it requires simple centrifuge with easy-to-follow protocol and laboratory staff with sterile technique due to an open-system. Our limitations were short time follow-up, subjective primary outcome as VAS, and too small sample size to detect the statistically significant of treatment failure.