The Jerome et al. review highlights that while intradiscal orthobiologic injections show clinical promise, they carry a small but serious risk of spondylodiscitis, with a literature-based complication rate between and 0.74% for intradiscal mesenchymal signaling cell (MSC) injections and 0.52% for platelet-rich plasma (PRP) injections based on published clinical data. The authors present three new cases of discitis following Bone Marrow Concentrate (BMC) injections, suggesting that the extensive handling required for BMC and the disc’s avascular, hypoxic environment may increase susceptibility to infection or the overgrowth of an innate disc microbiome (e.g., C. acnes). To mitigate these risks, the study recommends a stringent safety protocol consisting of a double-needle delivery technique, the use of leukocyte-rich PRP for its antimicrobial properties, and the inclusion of intradiscal gentamicin within the injectate.
To mitigate the risks, the authors advocate for a “triple-prophylaxis” approach: administering intravenous (IV) antibiotics (such as cefazolin) before the procedure and mixing intradiscal gentamicin (typically 500 mcg) directly into the contrast or injectate. They also suggest using leukocyte-rich PRP, noting that the white blood cells within the preparation may provide an additional inherent antimicrobial effect.
