A Systematic Review and Meta-Analysis of Randomized Controlled Trials of Epidural Regenerative Medicine Therapies in Managing Spinal Pain.

PURPOSE OF REVIEW: This review aims to assess the effectiveness of epidural injections of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) in treating chronic spinal pain. While existing literature has primarily concentrated on intradiscal regenerative therapies, this systematic review focuses specifically on the efficacy of PRP and MSCs when administered into the epidural space for managing chronic spinal pain.

RECENT FINDINGS: Due to their anti-inflammatory and regenerative properties, emerging studies underscore the therapeutic promise of epidural biologics, including MSCs, platelet-rich plasma, and alpha-2-macroglobulin. Epidural administration offers key advantages: it avoids the risk of discitis and minimizes the chance of disc injury from needle penetration. Moreover, this route enables simultaneous treatment of multiple affected discs without discography or multiple intradiscal injections. This is particularly relevant in elderly patients who often present with advanced disc degeneration and narrowed disc spaces, making intradiscal injections technically difficult. Clinical findings suggest notable improvements in pain reduction, physical functionality, and overall quality of life following these epidural treatments. A total of 9 randomized controlled trials (RCTs) were included in the review to evaluate epidural biologics for chronic spinal pain management. No RCTs investigating stem cells were identified. The quality of evidence was rated as fair (Level III), with moderate effect size and recommendation strength based on a qualitative synthesis and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology.