Is Prolotherapy an Effective Long-term Management for Discogenic Low Back Pain? – A Case Study with 10 Year Follow Up

Abstract

Discogenic low back pain (DLBP), has been reported to account for 39% of all chronic lower back pain. Several studies have also concluded that the presence of a high intensity zone (HIZ) in the annulus on T2-weighted sagittal lumbar MRI and in the context of a DLBP pattern, (88-99% correlation), suggest that an annular fissure of the disc is the main pain generator. Nevertheless, finding effective non-surgical long-term pain management solutions for chronic DLBP remains challenging. Prolotherapy, also known as Sclerotherapy, ‘Bongling’ or Regenerative injections, commonly utilizes substances such as dextrose, dextrose-glycerol-phenol (Ongley’s Solution or P2G), and sodium morrhuate. Targeted injections of these solutions into the tendon enthesis, facet joints space, and lumbosacral ligaments, aims to stimulate natural healing processes through inflammation, thereby optimizes lumbar motor unit stability, which in turn may relieve pain. Accurate lumbar ligament injection delivery requires practical knowledge of anatomical landmarks, but may also be performed under ultrasound or fluoroscopic guidance. There are few studies reviewing the sustained effects of prolotherapy for the management of chronic low back pain. This case report with 10-year post spinal prolotherapy follow up, reviews a patient with MRI-confirmed lumbar degenerative disc disease and an annular tear.