Understanding Lumbar Disc Herniation
Lumbar disc herniation is a common spine condition that can cause lower back pain, leg pain, numbness, weakness, and reduced mobility. It happens when part of a spinal disc pushes outward and irritates nearby nerves.
Many people improve with conservative care like physical therapy, medication, rest, and activity changes. However, when symptoms are severe or do not improve, surgery may be considered.
One minimally invasive option is percutaneous endoscopic lumbar discectomy, also known as PELD. This procedure removes the herniated disc material to help relieve nerve pressure while preserving more of the surrounding spinal structures compared with traditional open surgery.
While PELD can help relieve symptoms, it does not fully repair the underlying disc degeneration that may contribute to future problems. Because of this, researchers are studying whether regenerative tools like platelet-rich plasma may help support the healing environment after surgery.
Why PRP Is Being Studied
Platelet-rich plasma, or PRP, is made from a patient’s own blood and contains a concentrated number of platelets. Platelets release growth factors and signaling molecules that may help support tissue repair, inflammation balance, and healing.
In spine research, PRP is being studied because spinal discs have limited blood supply and do not always heal easily on their own. Researchers are interested in whether PRP may help support disc recovery after procedures like PELD.
For lumbar disc herniation, PRP may help support:
- Reduced inflammation around the injured disc
- Improved pain and function
- Tissue repair after discectomy
- Better preservation of disc height
- Lower risk of recurrent herniation
The goal is not for PRP to replace surgery, but to potentially support recovery when used alongside a minimally invasive procedure.
How the Study Was Designed
This 2025 systematic review and meta-analysis evaluated whether combining PELD with PRP injection may improve outcomes for lumbar disc herniation compared with PELD alone.
The researchers searched several major databases and included 4 eligible studies with a total of 421 patients.
Of those patients:
- 212 received PELD combined with PRP injection
- 209 received PELD alone
The review looked at recurrence rates, pain scores, disability scores, functional recovery, disc degeneration grading, and final follow-up disc height.
What Researchers Found
The study found that patients who received PELD plus PRP had a lower recurrence rate compared with those who received PELD alone. This is important because recurrent disc herniation can lead to returning pain, further treatment, and sometimes additional surgery.
Pain outcomes were also encouraging. Patients in the PRP group had lower leg pain scores at 3 and 6 months. Low back pain scores were also lower at 3 months and 12 months.
Functional improvement was more mixed. The PRP group showed better early disability scores shortly after treatment, but differences were not significant at later follow-up points. However, patients who received PRP had a higher rate of “excellent” outcomes based on the Macnab criteria, a tool commonly used to evaluate recovery after spine procedures.
The study also found that patients in the PRP group had better preservation of intervertebral disc height at final follow-up. They also had fewer cases of more advanced disc degeneration based on Pfirrmann grading, suggesting PRP may have a possible protective effect on disc structure.
How PRP May Support Disc Recovery
Lumbar disc herniation is not only a mechanical problem. Inflammation, disc degeneration, tissue breakdown, and reduced disc hydration can all contribute to pain and recurrence.
PRP may support recovery by releasing growth factors that help guide cell activity, tissue remodeling, and inflammation regulation. In the disc environment, these signals may help support nucleus pulposus cells, which are important for maintaining the inner portion of the disc.
PRP may also help support the extracellular matrix, the structural network that helps the disc maintain hydration, height, and cushioning ability. When this matrix breaks down, the disc may become more vulnerable to degeneration.
By combining PELD with PRP, researchers are exploring a two-part approach: surgery to relieve nerve compression and PRP to support the biological healing environment after treatment.
Why This Research Matters
This study is meaningful because it looks at a practical question in spine care: can PRP improve recovery after minimally invasive disc surgery?
The findings suggest that PRP may offer added support for patients undergoing PELD, especially in areas such as recurrence reduction, pain improvement, and disc height preservation.
For regenerative medicine, this supports the growing interest in PRP as an adjunct therapy. In this case, PRP is not being studied as a replacement for surgery, but as a biologic tool that may help improve the healing process after surgery.
What Still Needs to Be Studied
There were differences in how PRP was prepared and applied, including injection volume, blood volume used, and follow-up timing. Future studies should include larger randomized trials, longer follow-up, and more standardized PRP protocols.
Takeaway
This systematic review suggests that adding platelet-rich plasma injection to percutaneous endoscopic lumbar discectomy may provide extra support for lumbar disc herniation recovery. Compared with surgery alone, the combined approach was associated with lower recurrence rates, improved pain scores at certain follow-up points, better disc height preservation, and more “excellent” recovery outcomes.
While more research is needed, PRP remains a promising regenerative adjunct in minimally invasive spine care. By supporting inflammation balance, tissue repair, and disc recovery, PRP may help create a healthier healing environment after lumbar disc surgery.
Source
Song H, Zhang Y. The clinical efficacy of percutaneous endoscopic lumbar discectomy combined with platelet-rich plasma injection for lumbar disc herniation: a systematic review and meta-analysis. Frontiers in Surgery. 2025 May 27;12:1601772. doi: 10.3389/fsurg.2025.1601772. Available from: https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1601772/full
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