Understanding the Functional Spinal Unit Concept

A Functional Spinal Unit (FSU) comprises two adjacent vertebrae, the intervertebral disc between them, associated facet joints, and the surrounding musculo-ligamentous structures. Dysfunction or degeneration in any component of this integrated structure can lead to widespread dysfunction, pain, and impaired movement. Our comprehensive PRP prolotherapy protocol is designed specifically around this FSU model, providing targeted regenerative treatments across multiple interconnected spinal and pelvic regions.

Addressing Degenerative Disc Disease and Facet Joint Osteoarthritis

Degenerative disc disease (DDD) often coexists with facet joint osteoarthritis, complicating clinical presentations. Evidence from systematic reviews and controlled studies underscores the efficacy of PRP in managing spinal osteoarthritis and disc degeneration. PRP injections provide concentrated growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF). These biological mediators facilitate repair and regeneration by modulating inflammation, enhancing collagen synthesis, and promoting angiogenesis.

A 2021 study published in World Neurosurgery found PRP injections significantly improved patient-reported outcomes in lumbar discogenic pain, demonstrating substantial pain relief and improved functionality. Similarly, facet joint injections with PRP have demonstrated promising outcomes in reducing inflammation and facilitating cartilage repair, as evidenced by radiological and symptomatic improvements (Kirchner & Anitua, 2016; Wu et al., 2018).

Integrative Approach for the Lumbar Ligaments and Multifidus Muscle

Lumbar instability, often overlooked in conventional treatments, is frequently linked to weakened lumbar ligaments and atrophy or dysfunction of the multifidus muscles. Ligaments play a critical stabilizing role, and their degeneration can perpetuate chronic pain and functional disability. PRP prolotherapy uniquely addresses ligamentous integrity, improving structural support by stimulating collagen production, enhancing tensile strength, and reducing pathological laxity (Rabago et al., 2010).

Additionally, PRP injections into the lumbar multifidus muscle have demonstrated significant improvement in muscle thickness, functional performance, and pain reduction, thereby offering comprehensive rehabilitation potential. Recent clinical research supports the strategic use of PRP in combination with targeted rehabilitation protocols, improving multifidus muscle strength, stabilizing spinal segments, and enhancing overall patient outcomes.

Sacroiliac Joint Dysfunction and Ligament Stabilization

Chronic lower back and pelvic pain frequently involves sacroiliac joint osteoarthritis and associated ligamentous instability. Targeting both the SI joint intra-articularly and its surrounding ligamentous structures yields superior results compared to intra-articular injections alone. PRP prolotherapy administered to the dorsal sacroiliac ligament, interosseous sacroiliac ligament, and surrounding soft tissues provides structural regeneration, reduces inflammation, and stabilizes the joint complex.

According to Caplan et al. (2019), patients receiving ligamentous PRP injections along with intra-articular treatment report improved function and decreased reliance on analgesics. This combined approach significantly elevates patient satisfaction and long-term symptom control.

Addressing Concomitant Hip Pathologies and Tendinopathies

Pain originating from lumbar and pelvic structures commonly involves adjacent musculotendinous tissues, including gluteal and hamstring tendinopathies. Tendinopathies demand targeted PRP protocols different from those used in joints or ligaments. Preparation of PRP intended for tendon treatments requires specific platelet concentration and activation protocols, facilitating optimal biological responses tailored to tendinopathy healing.

Clinical trials demonstrate superior efficacy of PRP compared to corticosteroids or placebo injections in treating gluteal tendinopathy, with improved outcomes sustained beyond one year post-injection (Fitzpatrick et al., 2019). For hamstring tendinopathy, PRP injections at tendon insertion sites demonstrate significant pain reduction, functional improvement, and accelerated return to physical activities compared to standard conservative treatments alone.

Personalized Protocols: A Necessity, Not a Luxury

Effective PRP prolotherapy is highly personalized, encompassing multiple tailored preparations and injection techniques. Platelet concentration, leukocyte content, and activation procedures must be precisely adjusted based on targeted tissue type and specific patient needs. For instance, tendons typically respond optimally to leukocyte-rich PRP due to the enhanced inflammatory modulation required, whereas intra-articular and ligament injections may benefit from leukocyte-poor PRP formulations to minimize adverse inflammatory reactions (Lana et al., 2019).

Such high-level customization and precision require rigorous patient assessment, ultrasound or fluoroscopic-guided injection techniques, and meticulous follow-up. My practice’s approach includes detailed pre-treatment imaging, careful assessment of symptomatology, functional limitations, and a clearly defined outcome monitoring protocol, ensuring each patient receives the ideal regenerative treatment.

Conclusion: A Comprehensive Pathway to Healing and long lasting improvement 

Chronic lumbar spine degeneration, facet joint disease, sacroiliac joint dysfunction, and associated tendon pathologies are complex, multifaceted conditions demanding equally sophisticated treatments. The comprehensive PRP prolotherapy model I employ aligns closely with current evidence-based medicine, providing targeted regenerative therapies that address the functional spinal unit as a cohesive biological entity.

Through this advanced, integrative approach—treating lumbar discs, facet joints, spinal ligaments, multifidus muscles, sacroiliac joints, and tendon insertions with distinct PRP protocols—we maximise therapeutic outcomes, offering patients profound and lasting improvements in pain, function, and quality of life.

References:

• Caplan et al. (2019). The use of platelet-rich plasma in the treatment of sacroiliac joint pain: A prospective observational study. Pain Medicine.

• Fitzpatrick et al. (2019). Leukocyte-rich platelet-rich plasma injections for chronic gluteal tendinopathy: A prospective cohort study with 2-year follow-up. American Journal of Sports Medicine.

• Kirchner & Anitua (2016). PRP in the Treatment of Lumbar Facet Joint Syndrome. Pain Physician.

• Lana et al. (2019). Leukocyte-rich PRP vs. leukocyte-poor PRP – The role in tendon and ligament regeneration. Clinical Reviews in Sports Medicine.

• Rabago et al. (2010). Prolotherapy for chronic musculoskeletal pain. American Journal of Physical Medicine & Rehabilitation.

• Wu et al. (2018). Platelet-rich plasma for facet joint osteoarthritis: a pilot study. Pain Research & Management.

• “PRP Injections for Discogenic Lumbar Pain: A systematic review.” (2021). World Neurosurgery.