Ultrasound-Guided Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar Disc Herniation: A Prospective, Randomized, Controlled Study

Abstract

Transforaminal steroid injection is extensively used as a treatment in cases of herniated disc, but it is associated with complications. In comparison, platelet-rich plasma (PRP) injection has been used in musculoskeletal disorders and could be another option. This study is aimed at comparing the efficacy and safety aspects between ultrasound-guided transforaminal injections of PRP and steroid in patients who suffer from radicular pain due to lumbar disc herniation. In a randomized controlled trial, ultrasound-guided transforaminal injections of either PRP ( n = 61 ) or steroid ( n = 63 ) were administered to a total of 124 patients who suffer from radicular pain due to lumbar disc herniation. Patients were assessed by the visual analogue scale (VAS), pressure pain thresholds (PPTs), Oswestry disability index (ODI), and the physical function (PF) and bodily pain (BP) domains of the 36-item short form health survey (SF-36) before operation and 1 week, 1 month, 3 months, 6 months, and 12 months after operation. The rate and latency of F-wave were obtained before operation and 12 months postoperation. There was no statistical difference in terms of age and sex between both groups. Statistically significant improvements from the patients’ data before operation to data obtained 1-month postoperation were observed in VAS, PPTs, ODI, and PF and BP of SF-36 in both groups and kept for 1 year. F-wave rate and latency were improved significantly at 1-year postoperation in both groups. Intergroup differences during follow-ups over a period of 1 year were not found to be significant in all the above assessment between the PRP and steroid groups. No complications were reported. The results showed similar outcome for both transforaminal injections using PRP and steroid in the treatment of lumbar disc herniation, suggesting the possible application of PRP injection as a safer alternative. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INR-17011825).

Platelet Rich Plasma and Platelet-Related Products in the Treatment of Radiculopathy—A Systematic Review of the Literature

“…The remainder of patients received ESIs. A total of six studies with 218 patients received epidural PRP [ 4 , 21 , 22 , 23 , 24 , 26 ]. Lemper et al used PRP diluted in platelet-poor plasma (PPP) in one patient [ 17 ].…”

“…One study included a subject with cervical and lumbar radiculopathy [ 17 ] and another two studies [ 20 , 25 ] enrolled subjects with either cervical or lumbar radiculopathy. The remaining studies included only lumbar radiculopathy [ 3 , 4 , 6 , 18 , 21 , 22 , 23 , 24 , 26 ].…”

“…Some studies described in detail the sequence and methods of PRP or platelet-derived product [ 6 , 18 , 19 , 21 , 22 , 23 , 25 ], and one study referred to their previous published protocols on PRP preparation [ 26 ] while others did not provide any details [ 4 , 17 , 20 ]. In the studies using PRGF, products were activated with calcium chloride following centrifugation and before application [ 19 , 25 ].…”

“…Injections were fluoroscopy-guided in most studies [ 4 , 6 , 18 , 19 , 23 , 24 , 25 , 26 ], although two studies [ 22 , 26 ] used ultrasound guidance, and one study used computed tomography (CT) guidance [ 21 ]. The majority of studies injected subjects at one time point but five studies [ 17 , 18 , 20 , 24 , 25 ] performed repeat injections.…”

“…Six studies used the Visual analogue scale (VAS) to measure pain intensity [ 4 , 19 , 20 , 22 , 23 , 26 ] while one study used the Lattinen Index score [ 24 ]. The Lattinen test or index assesses chronic pain across five categories: pain intensity, pain frequency, use of analgesics, patient activity and hours of sleep.…”