A Systematic Review of Regenerative Medicine Therapies for Axial Spine Pain of Facet Joint Origin

This review aims to assess the effectiveness of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) injections in treating axial spinal pain originating from the facet joints. A systematic evaluation of available evidence on these biological therapies was conducted to determine their clinical utility.

Recent studies emphasize the therapeutic promise of intraarticular biologics, including MSCs, PRP, and alpha-2-macroglobulin, in managing facet joint-related axial spinal pain. Emerging evidence suggests improvements in pain relief, physical function, and quality of life following these treatments.

Based on our search criteria, 20 publications were identified and considered for inclusion. Of these, 4 randomized controlled trials (RCTs) and 6 observational studies met the inclusion criteria. Among the RCTs, 3 trials involved lumbar facet joints, and one trial involved cervical facet joints using PRP. Among the observational studies, 4 studies used PRP, with 3 focusing on the lumbar spine and one study, with 2 publications, on the cervical spine, and only 2 studies evaluated stem cell treatments. The summary of evidence utilizing various criteria, including Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) evidence synthesis, the evidence for PRP injections in facet joints is Level II, or moderate, and Level IV, or limited, overall, with low certainty. For PRP, the recommendation is moderate, and for MSCs, the recommendation is weak.