TREATMENT OF HERNIATED DISC WITH IMMUNO-REGENERATIVE MEDICINE: PRESENT AND FUTURE

C.A. Morales-Portillo¹ , G. Martínez-Sánchez² , M. Bonetti³ , R. Martínez-Pérez⁴ , A. Alexander⁵

¹ Specialist in Anesthesiology and Pain Management, Institute of Medicine, CAMP, Málaga, Spain
² Freelance Scientific Advisor, Ancona, Italy
³ Department of Neuroradiology, Clinical Institute, “Città di Brescia”, Brescia, Italy
⁴ Resident physician, Southeast University Hospital, Arganda del Rey, Madrid, Spain
⁵ Neurosurgeon, European Neurosurgical Institute, Treviso, Italy

Correspondence to:

Annals of Stomatology 2025 January-April; 5(1): Ahead of Print
https://doi.org/10.69149/orthopedics/2025v7iss2_4

Received: 23 April 2025 Accepted: 11 June 2025

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Abstract

Herniated discs, particularly lumbar disc herniation (LDH), are a significant cause of morbidity worldwide. The incidence of LDH varies based on age, gender, occupation, and genetic predisposition, with middle-aged individuals (30-50 years), smokers, and those with higher body mass index (BMI) being at higher risk. The prevalence of symptomatic LDH is notably high, especially in individuals with low back pain accompanied by lower limb symptoms. The pathophysiology of LDH involves the extrusion of the nucleus pulposus through the annulus fibrosus, leading to nerve root compression and inflammation. Macrophages play a crucial role in the immune response to herniated discs. M1 macrophages are pro-inflammatory and contribute to extracellular matrix degradation, while M2 macrophages are anti-inflammatory and promote tissue repair.  Recent studies have investigated the application of regenerative therapies, including platelet-rich plasma (PRP) and ozone, to modulate the immune response and promote the transition from M1 to M2 macrophages. Ozone therapy has been shown to activate macrophages, promoting the phagocytosis of the extruded nucleus pulposus and facilitating the shift from an inflammatory to a reparative phase. PRP, rich in growth factors, enhances tissue regeneration and repair, further supporting the transition to M2 macrophages. The combination of PRP and ozone therapy offers a promising approach to treating herniated discs by enhancing the body’s natural healing processes. These therapies have demonstrated significant pain relief and functional improvement in clinical studies, with a favorable safety profile. Future research should focus on large-scale randomized controlled trials to validate these findings and establish standardized treatment protocols.

Keywords: hernial disc, macrophages M1, macrophages M2, ozone, platelet-rich plasma