Evaluation of the Effectiveness of Orthokine Therapy: Retrospective Analysis of 1000 Cases.

BACKGROUND: Osteoarthritis is a global health problem. Approaches to symptomatic treatment of its consequences in-clude biological methods, including autologous serum. The aim of the study was to evaluate the effectiveness of Orthokine therapy in our experience. MATERIAL AND METHODS: Retrospective analysis of 1000 cases. The results were evaluated on a modified McNab scale (A - excellent, B - good, C - fair, D - poor) two and six months after the end of therapy. The effectiveness of the therapy was estimated as the percentage of satisfactory (A or B) or unsatisfactory (C or D) results. RESULTS: Osteoarthritis of the lumbar spine (n = 400) and knee joint (n = 219) was the most common diagnosis. The highest percentage of patients with a grade A or B result after 6 months was seen with therapy of tennis elbow enthesopathy (88.2%), rotator cuff tendinopathy (72.0%), Achilles tendon tendinopathy (75.0%) and in the early stages of osteoarthritis of the knee (75.9%) and small joints of the hand (77.0%). For cervical and lumbar discopathy, treatment efficacy was at 56.0-62.0% regardless of the size of the hernia. Unsatisfactory results (C and D) predominated in the group of patients with lumbar spinal stenosis (66.1%), wrist osteoarthritis (66.7%), and especially in late-stage hip osteoarthritis (85.3 %). For the largest groups, the frequency of unsatisfactory results was analyzed for selected age ranges. A significant increase in this parameter in subjects over 75 years of age was only seen in patients with severe knee osteoarthritis. CONCLUSIONS: 1. Orthokine therapy is highly effective in cases of tendinopathy, enthesopathy, osteoarthritis of the small joints of the hand and in early stages of knee osteoarthritis. 2. Satisfactory results are achieved in the treatment of cervical and lumbar discopathy, while unsatisfactory results prevail in severe degenerative changes in the knee and hip joints and in spinal canal stenosis.

Biological, Mechanical or Physical? Conservative Treatment of Cervical Radiculopathy.

BACKGROUND: There is equivocal evidence in support of the effectiveness of each of the three co-existing approaches to conservative treatment of cervical radiculopathy (CR): biological (regenerative), mechanical (decompression) and physical (analgesic and anti-inflammatory). The aim of the study was to compare the effectiveness of the three treatment approaches in CR. MATERIAL AND METHODS: A total of 90 patients were assigned to six treatment groups. Biological treatment: 4 ultra-sound-guided periradicular injections of ACS or PRP (1 per week); Mechanical treatment: manual therapy (MT) or traction therapy (TT) - 8 ses-sions (two per week); Physical treatment: laser therapy (LT) or collagen magnetophoresis (CM) - 8 sessions (two per week). As-sessment: before therapy (W0), after completion of the treatment (W1), two months after completion (W2). Assessment tools: NRS (0-10), NDI (0-50), cross section root area in mm2 in ultrasound examination (CRA) and hand sensorimotor function test (DPT). RESULTS: The largest reduction in mean NRS, NDI and CRA values at W2 was observed with the biological treatments (NRS: ACS 71.7%, PRP 70.6%, NDI: ACS 61.5%, PRP 56.6%, CRA: ACS 23.6 %, PRP 25%). Improvement of hand sensorimotor functions was observed at both W1 and W2 only in the PRP group. The PRP group demonstrated a stronger analgesic effect than the ACS group at W1 (58.82% compared to 43.39%), but ACS therapy had the same effectiveness during the follow-up period. Other methods reduced pain and disability at W1, but further reduction of mean NRS values during the follow-up period was only evident in the CM group (32.25%), very mild in the MM (19.35%) and LT groups (18.75%), and the TT group actually demonstrated a regression (-5.58%). In 3 cases, TT exacerbated the symptoms, which resulted in termination of the therapy. CONCLUSIONS: 1. Biological treatments were more effective than mechanical and physical therapies in reducing pain, im-proving the disability index and proprioception of the hand both immediately on completion of therapy and after a follow-up period, which may suggest their regenerative properties. 2. Physical and mechanical therapies produced improvement in the above-mentioned indicators on completion of the therapy, but subsequently exerted a very slight effect during the follow-up period without evident regenerative effects; moreover, a regression of the results was actually recorded for traction therapy. 3. Caution should be paid when using traction therapy in the acute period of root oedema, due to possible signs of intolerance of the procedure and exacerbation of the discomfort.

Use of Autologous Serum in Treatment of Lumbar Radiculopathy Pain. Pilot Study.

BACKGROUND: The aim of the study was to determine the usefulness of autologous serum in the treatment of patients with signs of radicular compression in the course of lumbar discopathy. The treatment was based on the use of autologous conditioned serum (ACS, Orthokine). MATERIAL AND METHODS: A total of 15 patients with MRI-confirmed single-level nucleus pulposus herniation with signs of radicular compression without paresis in a clinical examination received 6 doses of ACS administered by the same doctor under ultrasound guidance from a posterolateral approach to the area of an intervertebral foramen. The clinical condition of the patients was reassessed at 1 month and 3 months after the administration of the last dose. Pain intensity was assessed with a scoring system and a VAS scale, and radicular oedema was assessed with the following clinical tests: one-leg stance (OLS test) and straight leg raise (SLR test); the disability level was measured with the Oswestry Disability Index. RESULTS: Out of 15 patients, 2 persons had to undergo surgery due to increasing pain. The other subjects showed a statistically significant reduction of pain and clinical signs of radicular compression as well as improved Oswestry scores. No radicular damage following injections or serious complications of the treatment were found. CONCLUSIONS: 1. The Orthokine therapy conducted under ultrasound guidance may be an interesting option in the treatment of compression radiculopathy in the course of radicular compression due to a herniated disc. 2. The present pilot study provides the rationale for studying larger groups of subjects in controlled studies over longer periods of time.