This paper, published in the International Journal of Spine Surgery (2021), investigates the safety and complications associated with injecting orthobiologics (like PRP and bone marrow concentrate) into spinal discs to treat chronic back pain. The statistical risk of serious infection following intradiscal PRP injection is approximately 0.52%, based on one reported event across 194 treated patients. For BMAC (bone marrow-derived) injections, the risk is slightly higher at approximately 0.74%, with one reported infection among 136 patients in the published literature. The authors note that bone marrow-based procedures may carry a greater risk than PRP due to the more intensive handling and processing required outside the sterile field, as well as the use of larger-gauge aspiration needles. Furthermore, the risk of infection is compounded by the disc’s “immunoprivileged” status; its lack of blood supply makes it difficult for the body to mount an immune response, often turning a small bacterial introduction into a serious case of spondylodiscitis.
To mitigate the risk of infection, the authors recommend the local administration of 500 mcg of intradiscal gentamicinmixed with the contrast or injectate during the procedure.This local prophylaxis is paired with systemic IV antibiotics, such as cefazolin, administered before the procedure begins.
