Risks of Intradiscal Orthobiologic Injections: A Review of the Literature and Case Series Presentation

Area of Science:

• Orthopedics
• Regenerative Medicine
• Spinal Surgery

Background:

• Intervertebral disc disease (IDD) is a major cause of back pain with limited treatment options.
• Biologically based injections are being explored for IDD, but potential risks are emerging.
• This review summarizes known risks of intradiscal biologic injections and suggests mitigation strategies.

Purpose of the Study:

• To review complications associated with human intradiscal autologous biologic injections.
• To present a case series of serious adverse events (SAEs) from clinical practice.
• To recommend strategies for mitigating risks of intradiscal injections.

Main Methods:

• Literature review of human intradiscal mesenchymal signaling cell (MSC) and platelet-rich plasma (PRP) injection studies.
• Review of complications from intradiscal orthobiologic injections at a single outpatient center.
• Inclusion of three unpublished SAE cases.

Main Results:

• MSC injections (136 patients) reported two SAEs: one infection and one disc herniation.
• PRP injections (194 patients) reported one SAE.
• Three unpublished SAEs included one confirmed Cutibacterium acnes infection and two presumed discitis cases.

Conclusions:

• Biologic intradiscal injections offer potential for discogenic back pain but have inherent risks.
• Recommendations include using leukocyte-rich PRP, a two-needle technique, and intradiscal gentamicin.
• Further research with large registries is needed to track outcomes and complications.