Intradiscal Platelet Rich Plasma Injection for Type I Modic Change Associated with Low Back Pain in Osteopenia

Low back pain (LBP) has the highest prevalence globally among musculoskeletal conditions and is the leading cause of disability worldwide. A strong positive association between Modic type I change and LBP has been reported in most studies, but the prevalence varies greatly. There is no standard treatment protocol for Modic type I change at present. Intradiscal PRP injection is found to be effective in degenerative spinal disease in terms of improving pain and functional status. This study assessed the effect of intradiscal PRP (Platelet rich plasma) in type I Modic change associated LBP and the change of Modic type 1 on magnetic resonance imaging (MRI). PRP was injected intradiscally at the L4/5 disc under intermittent fluoroscopy. After 6 months, an MRI of the lumbar spine was carried out to see the changes in Modic type I. Assessment of pain by visual analogue scale (VAS) and disability by Roland‐Morris disability questionnaire (RMDQ) was done at different time intervals (pre-injection and post-injection at 1 week, 1 month, 3 months, 6 months, and 12 months). Quality of life was measured by 12-item short form health survey (SF-12) before injection and after injection of PRP (1 month, 3 months, 6 months, and 12 months). A clinically significant reduction of pain and disability was observed after PRP injections. The VAS score decreased from 7/10 to 3/10 and the RMDQ score from 13/24 to 5/24 after the last observation at 12 months. Improvement in quality of life was also observed at 12 months post-injection, as assessed by the SF-12 (PCS from 43.3 to 68.3 and MCS from 40 to 60). A decrease in high signal intensity on T2WI was seen in the follow-up MRI compared to before the PRP injection. No adverse events following intradiscal PRP injection were observed during this period. In conclusion, intradiscal PRP injection is effective for LBP patients with type 1 Modic change. More prospective studies are needed to establish the safety and efficacy of PRP in type I modic change associated with low back pain.