Intradiscal regenerative therapy

It is the injection of biologically active material (PRP, CGF, Lipogems® or BMAC) directly into the intervertebral disc under fluoroscopy or CT navigation. The aim is to stimulate regeneration of the nucleus pulposus, restore disc hydration and height, and reduce discogenic pain. This is a pathogenetic method that targets the cause of degeneration, not the symptoms.

Steroid blocks provide temporary (4–12 weeks) relief through their anti-inflammatory effect but do not treat the cause. Repeated blocks damage the epidural fat, weaken immunity and increase the risk of osteoporosis and avascular necrosis. Regenerative intradiscal therapy restores disc structure — effect lasting 2–5 years, without corticosteroid side effects.

When proper technique is used — yes. The procedure is performed under fluoroscopy with thin needles (22G–23G) that pass safely past nerve roots. A prophylactic antibiotic is given 30 minutes before the procedure (discitis risk 0.01–0.1%). An experienced specialist with 1000+ intradiscal procedures has a virtually zero complication rate.

It depends on the size of the herniation, the symptoms and the dynamics. For herniations up to 15 mm without sequestration, no progressive paresis and no cauda equina syndrome — intradiscal therapy + epidural PRP avoid surgery in 75–85% of cases. For large sequestered herniations with paresis, surgery is preferable. The decision is based on MRI plus neurological status.

Most often 1 procedure — the comprehensive MIBRAR® protocol: epidural CGF (or PRP) + intradiscal CGF + facet blocks if needed. In severe cases (FBSS, multiple levels) — 2–3 procedures spaced 6–8 weeks apart. A maintenance procedure usually after 24–36 months.

According to MIBRAR® internal statistics and meta-analyses: disc herniation up to 15 mm without sequestration — 75–85% significant improvement, protrusions — 90%, radicular syndrome without paresis — 80%, purely discogenic pain — 70%, FBSS — 65–75%. The key factor is correct patient selection and accurate identification of the pain generator.

For radicular syndrome — pain reduction in the first 2–4 weeks (CGF suppresses neuro-inflammation). For discogenic pain — slower: 6–12 weeks before improvement starts, peak at 6 months. Control MRI at 6 months shows morphological changes: restored disc hydration (Pfirrmann), reduced herniation size in 60–70% of patients.

Yes. With multiple problem discs (typical of patients aged 50+), several levels are treated in one procedure. Standard — up to 3 levels simultaneously. With more — prioritisation by "pain generators" via provocative discography. Costs are calculated per level.

Absolute: active infection (systemic or local), recent (<3 months) bacteraemia, spinal tumours, cauda equina syndrome (which requires urgent surgery). Relative: thrombocytopenia <100?10?/L, severe anxiety/depression component (psychotherapy is needed before the procedure), active anticoagulant use (temporary discontinuation is required).