Deep or Superficial? Autologous Conditioned Serum for Cervical Pain with Degenerative Disc Disease – a Randomized Controlled Trial

Background: Cervical pain of degenerative origin presents a therapeutic challenge due to multiple potential pain generators and the lack of a clear correlation between radiological changes and symptom severity. Autologous conditioned serum (ACS, Orthokine) has demonstrated anti-inflammatory and regenerative effects in musculoskeletal disorders. Purpose: This study compared the efficacy of ultrasound-guided fascial versus periarticular administration of ACS in patients with cervical disc disease. Patients and Methods: In this single-center, prospective, randomized trial (ISRCTN38950110), 100 patients of the local population with MRI-confirmed cervical disc degeneration neck pain were allocated to two groups: A (n=50) - fascial infiltration (superficial ACS administration using the hydrodissection technique around the tender points - increased soreness area, which suggest Low Grade Inflammation, LGI) or B (n=50) - periarticular injection (deep administration around cervical facet joints along articular column). Both interventions were performed under ultrasound guidance by the same operator. Pain intensity (Numerical Rating Scale, NRS) and disability (Neck Disability Index, NDI) were assessed at baseline (Initial Assessment, IA) and after 6- (6W), and 12-weeks (12W) post-treatment, while functional test of dynamic proprioception (Dynamic Proprioception Test, DPT) was assessed at baseline (IA) and 12-weeks (12W) post-treatment. Results: Both groups showed significant improvement over time in NRS and NDI scores (p < 0.001), with no significant between-group differences or time × group interaction. Mean NRS decreased from 4.7 ± 2.2 to 2.1 ± 1.9, and mean NDI from 16.3 ± 7.7 to 8.3 ± 6.1 after 12 weeks. No relevant changes were observed in DPT results. Conclusion: Fascial and periarticular ACS injections provided comparable pain and disability reduction after 12 weeks, suggesting that fascial infiltration, being less invasive, may serve as an effective therapeutic alternative for neck pain in degenerative disc disease.