Regenerative Procedures for Degenerative Disc Disease: What the Research Says About PRP, Stem Cells, and Orthobiologics

John K. Hong, M.D. | 7/22/2025

Degenerative disc disease (DDD) is a common cause of chronic low back pain, especially in aging adults. Traditionally managed with conservative care or surgery in severe cases, many patients now seek minimally invasive options that target the underlying pathology. Regenerative medicine offers a promising alternative through intradiscal biologic therapies such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and other orthobiologics. These treatments aim not just to relieve pain, but to promote healing within the disc itself.

Below is a look at the most studied regenerative options for DDD, along with key clinical research supporting their use.

Intradiscal Platelet-Rich Plasma (PRP)

What it is: PRP is an autologous biologic derived from the patient’s own blood, concentrated with platelets that release growth factors and cytokines to stimulate healing.

Mechanism of Action: When injected into the nucleus pulposus, PRP may reduce inflammation, modulate nociceptive signaling, and promote matrix synthesis, improving disc hydration and structural integrity.

Key Studies:

• Tuakli-Wosornu et al. (2016), Spine Journal

  • Design: Double-blind, randomized controlled trial (RCT)

  • Findings: Patients receiving intradiscal PRP experienced significantly greater pain relief and functional improvement at 8 weeks and 1 year compared to those receiving bupivacaine placebo injections.

  • Significance: One of the earliest RCTs supporting PRP for discogenic pain.

  • Link to abstract

• Navani et al. (2021), Pain Physician

  • Design: Prospective case series

  • Findings: Demonstrated sustained pain relief and functional improvement at 6 and 12 months post-PRP.

  • Comment: Supports the long-term benefit of PRP in a real-world clinical setting.

    
    

Mesenchymal Stem Cells (MSCs)

What they are: MSCs are multipotent stromal cells capable of differentiating into disc-like cells and secreting anti-inflammatory, anti-catabolic, and regenerative factors. Common sources include bone marrow and adipose tissue.

Mechanism of Action: Once injected into the disc, MSCs can modulate the immune environment, suppress inflammation, and promote regeneration of the nucleus pulposus extracellular matrix.

Key Studies:

• Pettine et al. (2015), Stem Cells International

  • Design: Prospective study with intradiscal bone marrow-derived MSCs

  • Findings: Over 70% of patients experienced significant improvements in pain and function at 1-year follow-up. MRI showed signs of disc height restoration in some cases.

  • Link to full text

• Noriega et al. (2017), Transplantation (RCT)

  • Design: Phase II RCT using allogeneic umbilical cord-derived MSCs

  • Findings: Showed pain relief and functional improvement with no serious adverse events.

  • Significance: Demonstrated safety and efficacy of allogeneic MSCs in discogenic pain.

• Coric et al. (2022), Neurosurgery

  • Design: Randomized, double-blind, controlled study using mesoblast (allogeneic MSCs)

  • Findings: Significant pain reduction at 24 months and reduced need for surgical intervention compared to controls.

  • Link to abstract

    
    

Other Orthobiologics and Emerging Therapies

• Growth Factor Injections (e.g., BMP-7, TGF-β):

  • Early-phase studies suggest anabolic effects on disc cells, but risks of ectopic bone formation and off-target effects remain concerns.

• Amniotic Fluid and Tissue Products:

  • Rich in growth factors and anti-inflammatory molecules; limited but growing evidence supports their safety and possible efficacy.

• Exosomes and Nanoparticles:

  • Still in preclinical or early clinical phases. These offer a cell-free method of delivering regenerative signaling to the disc.

    
    

Limitations and Considerations

• Patient Selection:Regenerative procedures appear most effective in patients with mild to moderate disc degeneration (Pfirrmann grades III–IV), maintained disc height, and absence of significant Modic type I changes.

• Regulatory Status:

  • PRP is FDA-compliant under minimal manipulation rules.

  • MSCs are under tighter FDA regulation if expanded or cultured.

  • Allogeneic biologics (e.g., umbilical cord MSCs) must comply with IND or clinical trial pathways.

• Cost and Insurance:Most regenerative procedures are not covered by insurance and are considered cash-pay treatments.

  
  

Conclusion

Regenerative therapies for degenerative disc disease—especially intradiscal PRP and MSCs—show promise in alleviating pain and possibly restoring disc health. As research continues to mature, especially through randomized trials and long-term data, these biologic options may become a mainstay in spine care. For now, patient selection, realistic expectations, and evidence-based protocols are key to successful outcomes.

Interested in exploring regenerative options for disc pain?

Contact Parkview Pain and Regenerative Institute to schedule a consultation and learn more about cutting-edge non-surgical solutions for back pain.