The effectiveness of platelet-rich plasma in acceleration of reinnervation process of damaged spinal nerve due to disc herniation.

The effectiveness of platelet-rich plasma in acceleration of reinnervation process of damaged spinal nerve due to disc herniation. | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 3 June 2025 V1 Latest version Share on The effectiveness of platelet-rich plasma in acceleration of reinnervation process of damaged spinal nerve due to disc herniation. Authors : Sarvar Bebitov 0009-0009-5425-6611 [email protected] , Yakutkhan Madjidova , Sayyora Bazarova , Dilfuza Temirova , and Madina Gafurova Authors Info & Affiliations https://doi.org/10.22541/au.174892324.46637932/v1 208 views 93 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Degenerative disc disease (DDD) presents an autoimmune inflammation process with an expression of cytokines (interleukin [IL]-1β, tumor necrosis factor [TNF]-α, IL-6, IL-8, IL-17, and interferon [IFN] -γ) leading to increase the expression of aggrecenases and matrix-degrading proteases causing the destruction of disc tissue1,2,3,4. Deterioration of annulus fibrosis ends with formation of protrusion and disc herniation (DH). Prolapsing of nucleus pulposus shrinks the spinal canal leading to the secondary stenosis and spinal nerve compression. In this condition the inflammation process spreads around tissue and nerve. Beside the compression, inflamed spinal nerve will be pain generator per se with demonstration of motor deficit. Sometimes vertebrae’s listesis leads to foraminal stenosis and spinal nerve compression or ligament stretching being the main cause of the pain. Also, an inborn spinal canal stenosis worsens DDD symptoms and increases the probability of the surgery. The development of denervation process without reinnervation disables any conservative treatment tactics. Perhaps in the early stages of DDD the cellular therapy adding bioactive substances will have any opportunity to stop degeneration and, maybe, stimulate some regeneration, but never prevents from development of DH under abnormal biomechanical conditions. Several scientific works have been carried out related to Platelet-Rich Plasma (PRP) injection inside the disc9,10,11,12, but none has been reported about PRP injection or other cellular therapy at late stage. In this case report, two patients with sciatica and peripheral paresis due to DH, spinal canal stenosis and spinal nerve inflammation have been reported being saved from surgical intervention after local PRP injection. Bebitov Sarvar А. 1 , DS. professor Madjidova Yakutkhan N. 2 , MD, DS Bazarova Sayyora A. 1 , Temirova Dilfuza R. 1 , Gafurova Madina Sh. 1 1 Military hospital in Tashkent, neurology department: Tashkent, Uzbekistan, Qora-qamish street, 100109. [email protected] , [email protected] , [email protected] , [email protected] , Tel.: +99897 442 79 89. 2 Tashkent Pediatric Medical Institute, neurology and pediatric neurology, medical genetics department, Tashkent, Uzbekistan. Bog’i shamol Street 223, 100140. [email protected] Tel.: +99893 171 22 48, fax: +998 71 262 33 20. not-yet-known not-yet-known not-yet-known unknown Author note Bebitov S.A. ID https://orcid.org/0009-0009-5425-6611 Acknowledgement: We thank the volunteer who participated in this study, as well as staff at Kimyo international university hospital for administrative support and for enrolling the study participant. Dr. Pak Marina Vissarionovna is thanked for conducting electrodiagnostic examination and evaluating the assessment of damaged nerve function in the feature beforehand. We also appreciate the stuff of the laboratory and technical assistance of x-ray guidance. The responsibility for the content and any remaining errors, omissions, and inaccuracies is our own. No funding source was involved in the design or conduct of the research or preparation of the manuscript, and the analyses and opinions expressed are those of the authors alone. We have no known conflict of interest to disclosure. Informed consent was obtained. Main author Dr. Bebitov Sarvar A. carried out retrodiscal, epideural, infraneural and interlaminar PRP as well as steroid injection under x-ray guidance to both patients. In addition to this, he was responsible for the second patients’ medical report as a main physician and did the literacy search while Dr. Temirova Dilfuza was technical assistance during x-ray guidance and helped to prepare PRP. Additionally, she presided 1st patient’s documents. Dr. Gafurova Madina presided 2nd patient’s documents. The manuscript was written by Dr. Bebitov Sarvar. DS. professor Madjidova Yakutkhan is supervisor and controlled the job as well as contributed to the study design. DS Bazarova Sayyora A. is deputy chief of staff and organized work in operation room. Correspondence concerning this article should be addressed to Bebitov S.A., Kimyo international university hospital, Tashkent, Uzbekistan, Gavhar Street, 100121. Data availability: The data supporting the findings of this study are available from the corresponding author upon reasonable request. E-mail: [email protected] not-yet-known not-yet-known not-yet-known unknown Background: Degenerative disc disease (DDD) presents an autoimmune inflammation process with an expression of cytokines (interleukin [IL]-1β, tumor necrosis factor [TNF]-α, IL-6, IL-8, IL-17, and interferon [IFN] -γ) leading to increase the expression of aggrecenases and matrix-degrading proteases causing the destruction of disc tissue1,2,3,4. Deterioration of annulus fibrosis ends with formation of protrusion and disc herniation (DH). Prolapsing of nucleus pulposus shrinks the spinal canal leading to the secondary stenosis and spinal nerve compression. In this condition the inflammation process spreads around tissue and nerve. Beside the compression, inflamed spinal nerve will be pain generator per se with demonstration of motor deficit. Sometimes vertebrae’s listesis leads to foraminal stenosis and spinal nerve compression or ligament stretching being the main cause of the pain. Also, an inborn spinal canal stenosis worsens DDD symptoms and increases the probability of the surgery. The development of denervation process without reinnervation disables any conservative treatment tactics. Perhaps in the early stages of DDD the cellular therapy adding bioactive substances will have any opportunity to stop degeneration and, maybe, stimulate some regeneration, but never prevents from development of DH under abnormal biomechanical conditions. Several scientific works have been carried out related to Platelet-Rich Plasma (PRP) injection inside the disc9,10,11,12, but none has been reported about PRP injection or other cellular therapy at late stage. In this case report, two patients with sciatica and peripheral paresis due to DH, spinal canal stenosis and spinal nerve inflammation have been reported being saved from surgical intervention after local PRP injection. Case report: DH and vertebral canal stenosis were diagnosed in two patients (D.R. 25 year old, and A.A. 47 year old) with neurological deficits. Both with different times of evolution and similar symptoms with some differences: Sciatica and sensory impairment in the left leg bothered 1st patients while sciatica, sensory impairment and proximal peripheral paresis in the right leg were observed in 2nd patient. Owing to the failing of conservative treatment, they were admitted to our hospital. After complementary studies (TNF-α in blood, magnetic resonance imaging (MRI), nerve conduction study (NCS) and needle electromyography (EMG) surgical intervention was recommended. Both refused. Low back pain with irradiating to the left leg started to bother 1st patient (D.R.) 10 days ago before admitting while 2nd patient (A.A.) has been suffering from low back pain for several years and transligamentous discectomy at L4-L5, L5-1 levels was performed in 2005y. However, A.A. felt low back pain with irradiation to the right leg and weakness in August of 2024y after getting cold. Despite the treatment, pain’s intensity decreased mildly, additionally weakness of the right thigh muscles and hypotrophy appeared. Due to the ineffectiveness of the conservative treatment he was admitted to our hospital in February. Contrary, D.R. was an athlete and played volleyball regularly and sciatica started 10 days ago until admitting while volleyball competition was being held. Both patients were undergone MRI, NCS of peripheral nerves and needle EMG examinations. To assess an inflammation process activity, C-reactive peptide, interleukin-6 and TNF-α were tested in blood. On MRI, disc degeneration, protrusion at L3-L4 level, DH at L4-L5, L5-S1 levels, hypertrophy of ligamentum flavum and spinal canal stenosis were found in 1st patient (1st picture) whereas L5 vertebrae’s spondilolistesis, recess stenosis, DHs relapses and spinal nerves bulging could be seen in 2nd patient (2nd picture). Needle EMG showed active denervation process in 2nd patient (4th picture) while NCS was normal in the first patient (3rd picture). As needle EMG can reveal any changes within about 1,5 months after acute process EMG examination did not carry out in 1st patient. Conservative treatment was ineffective in both patients. Both patients refused surgical intervention. That is why, at L4-L5, L5-S1 levels retrodiscal, epidural and at L4-L5 level interlaminar, epidural steroid (Betamethasone 1ml) injection in combination with 2% - 2ml Lidocaine was performed (5th picture) on the left sight in 1st patient. As for 2nd patient, retrodiscal, epidural steroid (Betamethasone 1ml) injection in combination with 2% - 2ml Lidocaine on the right sight was performed at L4-L5, L5-S1 levels under x-ray guidance (6th picture). Steroid injection helped to 1st patient with considerable decreasing the pain for 24 hours. However, on the second day, sciatica harassed, even paresis developed and patient started to limp on the left leg. At the same time, 2nd patient felt a moderately decrease of the pain. But, sensory loss, numbness and paresis remained on the right leg. The numbness and feeling a cool in the lower extremities of both patients remained. In spite of the failure of steroid injection, both patients refused surgical intervention. As in our practice two patients with peripheral paresis had been recuperated after PRP injection in the past, we decided to inject PRP locally to our new patients. In each segments including L4-L5, L5-S1 levels retrodiscal, epidural perineural area in both patients and additionally, interlaminal, epidural at L4-L5 level 2 ml PRP were injected under x-ray guidance in 1st patient. The injection was repeated 2 times in each patient and was carried out after every 6 days in 1st patient while it was done in every 4 days in 2nd patient. There are not any retrodiscal and infraneural PRP injection protocols in DH. As we have good results with PRP injection locally around the affected nerve and DH, we carried out local PRP injection in both patients too. After 2 times PRP injections both patients started to walk without claudication as well as numbness, feeling a cool, a segmental decrease of pain sensitivity and paresis disappeared within 24 hours. Only a mild pain in the right legs remained after 500 meters walking or 1 hour sitting in 1st patient, while analogous complaints started to harass 2nd patient after 700 meters walking and 2 hours standing. The presence of active denervation in needle EMG had encouraged us to inject PRP in a short period to fasten the reinnervation in 2nd patient. As there were only subjective complaints about the pain and sensitive disturbances, also mild and new paresis, we decided to inject second PRP after 6 days to avoid from possible complications. To increase healing process we decided to inject platelet poor plasma along the injected needle path while spinal needle was being pulled out. No complications had been observed after procedures. The inflammatory parameter (TNF-α) was previously high in 2nd patient and decreased very quickly. Inflammation biomarkers were normal in 1st patient before and after injection. Due to the improvement, patients were discharged. Pain regressed and paresis disappeared on discharging time. NCS and needle EMG repeated in 1st patient after 6 days from second PRP injection and after 11 days from development of peripheral paresis. NCS did not reveal any pathology whereas needle EMG exposed completed reinnervation (7th picture). As denervation process already existed in 2nd patient, NCS and needle EMG examination were repeated after month. There was not any pathology on NCS. Fully completed reinnervation with an increase of motor unite action potential’s (MUAP) amplitude and duration had been found on needle EMG (8th picture). On objective examination, no pathologic changes were found in other systems despite the nervous system. Only, 2nd patient suffered from constipation and his defecation was in every 3-4 days. Neurologic status on admitted time: For 1st patient – cranial nerves were normal. Paresis did not exist on admitted time. Nevertheless, after 5 days, peripheral monoparesis had developed in the left leg. Muscles strengths: 4 points in the proximal muscles and 3 points in the distal muscles were revealed out of 5 after development of paresis in the left leg. Other muscles’ power was normal. Muscles tones were slightly decreased in the left leg. Tendon reflexes: Biceps and triceps reflexes were excited equally on both sides whereas patellar and ankle reflexes were weaker on the left. Pathologic reflexes were not found. Hypoesthesia in the L5 segment on the left was revealed. Coordinator system was normal. Meningeal signs were negative. Lassegue I symptom was positive at 20° on the left. The function of the pelvic organs was not impaired. The paravertebral points in the lumbar region were painful. The tone of the paravertebral muscles on the left was increased. Cognition was normal. For 2nd patient on admitted time – cranial nerves were normal. Peripheral, proximal monoparesis was found in the right leg. Muscles strengths: 3 points were estimated in the right extensor group muscles of the thigh. Muscles tones were hypotonic in the proximal muscles group of the right leg. Hypotrophy was found in the right thigh group muscles in circumference with 4 centimeters proximally, 3 centimeters in the middle and 2 centimeters distally decrease. Tendon reflexes: Biceps and triceps reflexes were excited equally, whereas patellar and ankle reflexes were weaker on the right. Pathologic reflexes were not found. Hypoesthesia in the L5, S1 segments on the right was found. Additionally, patient felt tingling, cooling and numbness on the right leg. Coordinator system was normal. Meningeal signs were negative. Symptoms of tension were negative. Besides the constipation, function of the pelvic organs was not impaired. The paravertebral points in the lumbar region were painful. The tone of the paravertebral muscles on the right was slightly increased. Cognition was normal. In blood examination, 1st patient’s all parameters were normal. In 2nd patient, the level of TNF – α was 10,3 pg/ml (normal level until 2,5 pg/ml) on admitted time The other laboratory examinations were normal. 1st patient’s MRI showed disc degeneration, VL3-L4 protrusion, VL4-L5, VL5-S1 segments’ DH, hypertrophy of ligamentum flavum and spinal canal stenosis (1st picture). Spinal canal stenosis and DH were estimated as a cause of the pain and weakness. As for 2nd patient, L5 vertebrae’s spondilolistesis, recess stenosis, DHs relapses and spinal nerves bulging were found (2nd picture). Additionally, in 2nd patient, stabile L5 vertebrae’s spondilolistesis was proved on X-ray. NCS did not find any pathology in both patients while needle EMG revealed an active denervation process at the right L4, L5 and S1 segments in 2nd patient. In 1st patient, NCS did not expose any pathology at the first. But, after PRP injection, needle EMG found completed reinnervation without denervation process at the L3, L4, L5 and S1 segments on the left. Even spontaneous activities were not found. Patients were prescribed standard treatments until PRP injection. 1st patient was prescribed Tenoxicam 20mg intravenous, Etorikoksib 90mg orally, Tolperizone hydrochloride 300mg orally, Dexamethasone 8mg intravenous, Vitamin B complex intramuscular, L-lysine aescinat 10ml intravenous, pantoprazole 20mg orally, ultrasound therapy with diclofenac, sinusoid modulated electricity with procain hydroclorid, exercise and traction therapy. 2nd patient was treated with Dexcetoprofin 2ml intravenous, Bethamethazone 1ml+Diclofenac 3ml+Vitamin B12 intramuscular, L-lysine aescinat 10ml intravenous, pantoprazole 20mg orally, Tolperizone hydrochloride 300mg orally, Mirtazapine 7,5mg orally, Etorikoksib 90mg orally, Carbamazepine 400mg orally, ultrasound therapy with diclofenac, sinusoid modulated electricity with procain hydroclorid. Until admitting to our hospital 2nd patient was prescribed Dexketoprofenum 2ml intramuscular 10 days, Vitamin B complex intramuscular 10 days, pentoxifylline 5ml intravenous 10 days, Tizanidine hydrochloride 8mg orally 15 days, Omeprozole 20mg orally, Betamethasone+vitamin B12+diclofenac 3ml 5 days and physiotherapy (laser, magnet therapy, amplipulse therapy with analgesics and NSAID) several times. After that, there some decrease of pain had been observed, but not fully disappeared, paresis remained. However, conservative treatment failed in both patients. Additionally, peripheral paresis developed in 1st patient in spite of retrodiscal and interlaminar epidural steroid injection. Therefore patients were injected PRP. Retrodiscal, epidural and infraneural 2ml PRP 2 times to each L4-L5 and L5-S1 level was injected and 4ml Platelet-Poor Plasma (PPP) was also injected into the spinal canal through S1 foramen on the right in 2st patient whereas epidural, retrodiscal and subneural 2 times 2 ml PRP injection to the each L4-L5 and L5-S1 level was performed on the left in 1st patient. Additionally, at L4-L5 level, interlaminar epidural 2ml PRP injection was also carried out on the left side under x-ray guidance (5 – picture). To prepare PRP, 13.5 ml blood was taken from the patients’ venous blood under sterile conditions using a 20 ml syringe containing 1.5 ml of sodium citrate. The mixture of blood and anticoagulant was poured into a special YCELLBIO-KIT tube at an angle of 45º, after which 2 ml of PRP and 4 ml of PPP were obtained using an angular centrifuge with a frequency of 3600 Hz after 6 minutes rotation. After steroid and PRP injection course TNF – α decreased almost 4 times, from 10,3 pg/ml to 1,8 pg/ml in 2nd patient. The figure of TNF-α was normal in 1st patient. The power of muscles strength in both patients set up to 5 point and claudication disappeared. Due to the improvement they were discharged. To assess the effectiveness of the treatment, several scales were used, in particular, the visual analogue scale (VAS) for pain level, the modified MacNab scale (mMacNub) for the treatment effectiveness, the Oswestry low back disability index (ODI) for working ability, and the Nurick scale for the functional state of patients before and after steroid injection (Table 1). The results in the table №1 were taken on admitted time and after 2 days from steroid injection. After PRP injection courses the questioners were re-evaluated (Table №2). The effectiveness of the steroid injection. Table №1. Patients VAS мMacNub ODI Nurick upon admission After steroid injection upon admission After steroid injection upon admission After steroid injection 1 st 8 7 Unsatisfactory 88% 72% 4 3 2 nd 7 4 Satisfactory 84% 50% 3 2 The pain considerably decreased in 2 nd patient after steroid injection while it failed in 1 st patient due to spinal canal stenosis and cauda equina’s compression. Nevertheless, PRP could help to decrease the symptoms in both patients. According to the ODI the disability of both patients disappeared and returned to a mild disability, and started to carry out daily routines independently, performing social life’s tasks was restored. As for the Nurick scale, only mild radicular symptoms remained in short time period. The results after PRP injection courses. Table №2. Patients VAS мMacNub ODI Nurick After steroid injection upon discharge After steroid injection upon discharge After steroid injection upon discharge 1 st 7 0 Excellent 72% 18% 3 0 2 nd 4 1 Excellent 50% 14% 2 0 not-yet-known not-yet-known not-yet-known unknown Both patients were recommended kinesitherapy and exercise therapy. However, only second patient has been taking exercise therapy. 1st patient could not follow our instruction due to the job. Nevertheless, first patient fells himself well and only mild sciatica appears after 1 kilometer walking or after 1 hour standing. Paresis and sensory disturbances have disappeared. 2nd patient enrolled kinesitherapy course and his health is getting better. He feels only mild sciatica after 1,5-2 kilometers walking and 2-3 hours standing. Discussion: The nerve fibers are protected by three different layers of connective tissue: the epineurium, perineurium, and endoneurium. Together, the three layers give peripheral nerve considerable tensile strength, usually in the range of 20–30 kg. For this reason, nerve root avulsion may occur after a significant trauma and stretch injury13. Thereby, initially, the absence of peripheral paresis can be explained in 1st patient in condition of severe central spinal canal stenosis. But, compression of sensory root into the canal was a cause of severe radicular pain. Due to the sensory root compression in the canal until the spinal ganglion, NCS did not reveal any sensory disturbances, because bipolar nerve cell was intact. NCS is able to examine the distal part of the sensory nerve below the dorsal nerve ganglion. But this rule is not appropriate for the motor part, because the motor neurons are located in the anterior horn of the spinal cord. Any injuries of motor nerves generate Vallerian degeneration and will spread to the distal part of the nerve and this can be seen on NCS after 10-14 days. In 2nd patient, anterolistesis of L5 vertebrae caused foraminal stenosis leading to L5 spinal nerve compression, as well as L4-L5, L5-S1 DH relapses, right L5, S1 spinal nerves and spinal ganglion bulging with inflammation were main source of pain generation and motor nerve denervation leading to the peripheral paresis. To decrease the inflammation steroid injection was carried out in both patients. Due to the central and subarticular stenosis, retrodiscal steroid and PRP injection were performed at L4-L5 and L5-S1 levels in 1st patient. Subarticular stenosis was an obstacle to steroid leakage into the canal. So, L4-L5 interlaminar injection additionally was executed on the left side. There was not an obstacle in 2nd patient, so retrodiscal steroid and infraneural PRP injection were performed at L4-L5, L5-S1 levels. Steroid injection decreased the pain and inflammation in 2nd patient, but sensory disturbance and paresis remained. Also, steroid injection did not prevent from development of peripheral paresis in 1st patient. Steroid cannot stimulate reinnervation. Therefore, paresis remained in 2nd patient and even developed in 1st patient. To stimulate reinnervation process and recovery of the injured nerve PRP was injected around the spinal nerve. After axonal loss and denervation, the process of reinnervation can occur by one of two mechanisms. If there is severe or complete denervation, with no nearby surviving axons, the only possible mechanism for reinnervation is regrowth of the axon from the site of injury. Typically, this regrowth is quite slow (no more than 1 mm per day) and may take months to years, depending on the length of the nerve. As the axon regrows, at some point in time, it will reinnervate some, but not all, of the original muscle fibers. For the regrowth to occur, however, the anterior horn cells must remain intact. In contrast, in cases of partial or gradual denervation, reinnervation usually occurs through collateral sprouting by adjacent surviving motor units. As the number of muscle fibers per motor unit increases, MUAPs become prolonged in duration, with a high amplitude, and polyphasic. These MUAP changes, in conjunction with decreased recruitment, are the hallmarks of reinnervated MUAPs and nearly always imply chronic neuropathic disease. Similar to other neuropathic conditions, during maximal contraction, the interference pattern will not be full, secondary to decreased recruitment of MUAPs . Long-duration, high-amplitude, polyphasic MUAPs are never seen in acute conditions. When present, they always imply that the process has been present for at least several weeks and more often for months or years13. In 2nd patient process was chronic, but until PRP injection reinnervation process has not evolved. After PRP injection reinnervation process developed and peripheral paresis disappeared. In 1st patient, acute phase denervation did not developed fully, after PRP injection reinnervation has evolved in short period. The absence of polyphasy can confirm this. There was not polyphasy while an increase of MUAPs’ amplitude and duration were found due to the reinnervation. In 2nd patient, the process was chronic, so on second EMG, an increase of polyphasy, amplitude and duration of MUAPs can be seen while recruitment remained reduced. Despite the long duration of the disease and taking conservative treatment several times, reinnervation has not developed and sciatica remained in 2nd patient until performing local PRP injection. PRP stimulated reinnervation in both patients, after which paresis disappeared and sciatica regressed. PRP contains several growth factors including transforming growth factor-β, platelet-derived growth factor, epidermal growth factor, vascular endothelial growth factor and insulin-like growth factor that can inhibits degeneration, improves cell viability and extracellular matrix metabolism, stimulates proliferation of intervertebral disc cells6 and also has an anti-inflammatory effect by influencing cytokines and metalloproteinases2. In addition, the analgesic effect of PRP in degenerated tissues has been proven, but this effect does not last long9. Theoretically, PRP should stimulate regeneration and reinnervation of nerve tissue. This is proven in these two patients from their needle EMG results. Additionally, improvements in subjective symptoms (VAS, Mac Nub and ODI scales) and objective (TNF) parameter (in second patient) have been observed. The use of PRP in DH with neurological deficit is completely unusual and must be used as “the last chance”. Up to the present day we have carried out a lot of retrodiscal steroid injections in patients with DH, but all patients who were candidates for the surgery had been reluctant to the surgical intervention and refused ones were disabled. In our last practice, PRP injection in combination with steroid helped to reduce autoimmune inflammation decreasing TNF-α in a short time. Meanwhile, PRP stimulated the reinnervation leading to set up the spinal nerve function and paresis disappeared. According to the VAS, mMacNub, ODI and Nurik scales good results were also achieved. After procedures, the symptoms quickly regressed and they were saved from the surgery. Generally, denervation usually disappears after 2 – 3 months and after that period needle EMG reveals either fully reinnervation or denervation. In our practice reinnervation process has evolved in short period, even in the shortest period in 1st patient. Additionally, the level of TNF-α has decreased until the normal parameters in 2nd patient. 1st patient’s main problem was severe spinal canal stenosis and an active inflammation was not observed. These patients are a second case in our practice that have been saved from surgical intervention after local PRP injection. Nowadays, additional experimental work in association with local PRP injection is being carried out. Conclusion: Considering the above, this atypical treatment must be kept in mind when “the standard” has failed. Local PRP injection should be attempted in patients with DH who have an opportunity to reinnervation before being referred to the operation room. not-yet-known not-yet-known not-yet-known unknown References: Akeda K, An H.S, Pichika R, et al. Platelet-rich plasma (PRP) stimulates the extracellular matrix metabolism of porcine nucleus pulposus and annulus fibrosus cells cultured in alginate beads. Spine. 2006; 31(9):959–966. Kim H.J, Yeom J.S, Koh Y.G, et al. Anti-inflammatory effect of platelet-rich plasma on nucleus pulposus cells with response of TNF-α and IL-1. J Orthop Res. 2014; 32(4):551–556. Liu M.C, Chen W.H, Wu L.C, et al. Establishment of a promising human nucleus pulposus cell line for intervertebral disc tissue engineering. Tissue Eng Part C Methods. 2014; 20(1):1–10. Peng B, Hao J, Hou S, et al. Possible pathogenesis of painful intervertebral disc degeneration. Spine. 2006; 31(5):560–566. Weiler C, Nerlich AG, Zipperer J, Bachmeier BE, Boos N. 2002 SSE Award Competition in Basic Science: expression of major matrix metalloproteinases is associated with intervertebral disc degradation and resorption. Eur Spine J. 2002; 11(4):308–320. Chen WH, Liu HY, Lo WC, et al. Intervertebral disc regeneration in an ex vivo culture system using mesenchymal stem cells and platelet-rich plasma. Biomaterials. 2009; 30(29):5523–5533. Gruber HE, Norton HJ, Hanley EN, Jr. Anti-apoptotic effects of IGF-1 and PDGF on human intervertebral disc cells in vitro. Spine. 2000; 25(17):2153–2157. Feng H, Danfelter M, Strömqvist B, Heinegård D. Extracellular matrix in disc degeneration. J Bone Joint Surg Am . 2006; 88 Suppl 2:25–29. Freemont AJ, Watkins A, Le Maitre C, et al. Nerve growth factor expression and innervation of the painful intervertebral disc. J Pathol. 2002; 197 (3):286–292. Akeda K, Imanisha T, Ohishi K, et al. Intradiscal injection of autologous platelet-rich-plasma for the treatment of lumbar disc degeneration preliminary prospective clinical trial for discogenic low back pain patients. Poster no. 2194 presented at ORS Annual Meeting 2012. Nagae M, Ikeda T, Mikami Y, et al. Intervertebral disc regeneration using platelet-rich plasma and biodegradable gelatin hydrogel microspheres. Tissue Eng. 2007; 13(1):147–158. Sawamura K, Ikeda T, Nagae M, et al. Characterization of in vivo effects of platelet-rich plasma and biodegradable gelatin hydrogel microspheres on degenerated intervertebral discs. Tissue Eng Part A. 2009; 15(12):3719–3727. Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, et al. Lumbar intradiskal platelet-rich plasma (PRP) injections: a prospective, double-blind, randomized controlled study. PM R. 2016; 8(1):1–10, quiz 10. David C. Preston, Barbara E. Shapiro “Electromyography and Neuromuscular disorders. Clinical – electrophysiologic – ultrasound correlations” fourth edition. 2021; 25, 255-256. Supplementary Material File (mri picture of 1st patient.docx) Download 3.63 MB File (mri picture of 2nd patient.docx) Download 2.19 MB File (ncs and emg of patients.docx) Download 2.24 MB File (x-ray pictures.docx) Download 529.27 KB Information & Authors Information Version history V1 Version 1 03 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords degenerative disc disease disc herniation growth factors platelet-rich plasma Authors Affiliations Sarvar Bebitov 0009-0009-5425-6611 [email protected] Military hospital View all articles by this author Yakutkhan Madjidova Tashkent Pediatric Medical Institute View all articles by this author Sayyora Bazarova Military hospital View all articles by this author Dilfuza Temirova Military hospital View all articles by this author Madina Gafurova Military hospital View all articles by this author Metrics & Citations Metrics Article Usage 208 views 93 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Sarvar Bebitov, Yakutkhan Madjidova, Sayyora Bazarova, et al. The effectiveness of platelet-rich plasma in acceleration of reinnervation process of damaged spinal nerve due to disc herniation.. Authorea . 03 June 2025. 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