Regenerative Pain Therapy Using Platelet-Rich Plasma Compared with Steroid Injection for Spinal Disc Herniation: A Meta-Analysis
Abstract
Background: Radicular pain resulting from spinal conditions remains one of the most challenging problems for clinicians. This meta-analysis aimed to compare the interventional pain outcomes of platelet-rich plasma (PRP) injection versus steroid injection in patients with disc herniation.
Methods: A systematic review was conducted following PRISMA guidelines using PubMed, Science Direct, Cochrane Library, and RevMan 5.3. Three RCTs were analyzed.
Results: A total of 204 patients were included (PRP n = 101; control n = 103). There was no significant difference between the PRP and steroid for VAS (Visual Analog Scale), ODI (Oswestry Disability Index), and SF-36 scores at 3 and 6 months.
Conclusion: PRP provides similar pain reduction compared with steroid injection, with the additional advantage of potential regenerative effects. Further studies are warranted to evaluate structural regenerationKeywords
Full Text:
PDFReferences
1. Liu J, Zhou H, Lu L, Li X, Jia J, Shi Z, et al. The effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in managing Lumbo- sacral Radicular Pain: a systematic review and Meta-analysis. Med (Baltim). 2016;95(18):e3373.2. Manchikanti L, Falco FJ. Safeguards to prevent neurologic complications after epidural steroid injections: analysis of evidence and lack of applicability of controversial policies. Pain Physician. 2015;18(2):E129–383. Yang S, Kim W, Kong HH, Do KH, Choi KH. Epidural steroid injection versus conservative treatment for patients with lumbosacral radicular pain: a meta- analysis of randomized controlled trials. Med (Baltim). 2020;99(30):e21283.4. Anitua E, Padilla S. Biologic therapies to enhance intervertebral disc repair. Regen Med. 2018;13(1):55–72.5. Fabbro MD, Bortolin M, Taschieri S, Ceci C, Weinstein RL. Antimicrobia properties of platelet-rich preparations. A systematic review of the current pre-clinical evidence. Platelets. 2016;27(4):276–85. 6. Bhatia R, Chopra G. Efficacy of platelet Rich plasma via lumbar Epidural Route in Chronic Prolapsed Intervertebral Disc Patients-A Pilot Study. J Clin Diagn Res. 2016;10(9):Uc05–uc7.7. Cameron JATK. Autologous platelet Rich plasma for Neck and Lower Back Pain secondary to spinal disc herniation: Midterm results. Spine Res. 2017;3:2:10.8. Centeno C, Markle J, Dodson E, Stemper I, Hyzy M, Williams C, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38.9. Page, M. J., McKenzie, J. E., Bossuyt, P. M., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. International Journal of Surgery, 88, 1e11. https://doi.org/10.1016/j.ijsu.2021.10590610. Luchini, C., Veronese, N., Nottegar, A., et al. (2021). Assessing the quality of studies in meta-research: Review/guidelines on the most important quality assessment tools. Pharmaceutical Statistics, 20(1), 185e195. https://doi.org/10.1002/pst.206811. OCEBM Levels of Evidence d Centre for Evidence-Based Medicine (CEBM), University of Oxford. Published 2011. Accessed August 15, 2023. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence.12. Wongjarupong A, Pairuchvej S, Laohapornsvan P, Kotheeranurak V, Jitpakdee K, Yeekian C, Chanplakorn P. "Platelet-Rich Plasma" epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial. BMC Musculoskelet Disord. 2023 Apr 28;24(1):335. doi: 10.1186/s12891-023-06429-3. PMID: 37118707; PMCID: PMC10141936.13. Xu P, Wu Y, Zhou L, Yang Z, Zhang X, Hu X, Yang J, Wang M, Wang B, Luo G, He W, Cheng B. Platelet-rich plasma accelerates skin wound healing by promoting re-epithelialization. Burns Trauma. 2020 Aug 14;8:tkaa028. doi: 10.1093/burnst/tkaa028. PMID: 32821743; PMCID: PMC7427034.14. R. Ruiz-Lopez and Y. Tsai, “A randomized double-blind con- trolled pilot study comparing leucocyte-rich platelet-rich plasma and corticosteroid in caudal epidural injection for complex chronic degenerative spinal pain,” Pain Practice, vol. 20, no. 6, pp. 639–646, 2020.15. Filardo, G.; Di Matteo, B.; Kon, E.; Merli, G.; Marcacci, M. Platelet-rich plasma in tendon-related disorders: Results and indications. Knee Surg. Sports Traumatol. Arthrosc. 2016, 26, 1984–1999.16. Filardo, G.; Di Matteo, B.; Kon, E.; Merli, G.; Marcacci, M. Platelet-rich plasma in tendon-related disorders: Results and indications. Knee Surg. Sports Traumatol. Arthrosc. 2016, 26, 1984–1999.17. Belk, J.W.; Kraeutler, M.J.; Houck, D.A.; Goodrich, J.A.; Dragoo, J.L.; McCarty, E.C. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am. J. Sports Med. 2020, 17.18. Xuan, Z.; Yu, W.; Dou, Y.; Wang, T. Efficacy of Platelet-rich Plasma for Low Back Pain: A Systematic Review and Meta-analysis. J. Neurol. Surg. Part A Central Eur. Neurosurg. 202019. Falvo, E., Diviccaro, S., Melcangi, R. C., & Giatti, S. (2020). Physiopathological Role of Neuroactive Steroids in the Peripheral Nervous System. International Journal of Molecular Sciences, 21(23), 9000. https://doi.org/10.3390/IJMS2123900020. Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci. 2020 Oct 21;21(20):7794. doi: 10.3390/ijms21207794. PMID: 33096812; PMCID: PMC7589810.21. Deppermann, C.; Kubes, P. Start a fire, kill the bug: The role of platelets in inflammation and infection. Innate Immun. 2018, 24, 335–348.22. Chang, M.C., & Park, D. (2021). The Effect of Intradiscal Platelet-Rich Plasma Injection for Management of Discogenic Lower Back Pain: A Meta-Analysis. Journal of Pain Research, 14, 505 - 512.23. S. Bise, B. Dallaudiere, L. Pesquer et al., “Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain,” European Radiology, vol. 30, no. 6, pp. 3152–3160, 2020.24. P. Wu, R. Diaz, and J. Borg-Stein, “Platelet-rich plasma,” Physical Medicine and Rehabilitation Clinics of North America, vol. 27, no. 4, pp. 825–853, 2016.25. S. Arora, V. Doda, U. Kotwal, and M. Dogra, “Quantification of platelets and platelet derived growth factors from platelet- rich-plasma (PRP) prepared at different centrifugal force (g) and time,” Transfusion and Apheresis Science, vol. 54, no. 1, pp. 103–110, 2016.26. J. Qiao, N. An, and X. Ouyang, “Quantification of growth factors in different platelet concentrates,” Platelets, vol. 28, no. 8, pp. 774–778, 2017.27. Kumar R, Goni VG, Batra YK. Autologous conditioned serum as a novel alternative option in the treatment of unilateral lumbar radiculopathy: a prospective study. Asian Spine J. 2015;9:916–922.28. G. Smith, J. Pace, M. Strohl, A. Kaul, S. Hayek, and J. Miller, “Rare neurosurgical complications of epidural injections: an 8-yr single-institution experience,” Operative Neurosurgery, vol. 13, no. 2, pp. 271–279, 2017.29. J. Lee, E. Lee, G. Lee, Y. Kang, J. Ahn, and H. Kang, “Epidural steroid injection-related events requiring hospitalisation or emergency room visits among 52,935 procedures performed at a single centre,” European Radiology, vol. 28, no. 1, pp. 418–427, 2018.30. Kawabata, S.; Akeda, K.; Yamada, J.; Takegami, N.; Fujiwara, T.; Fujita, N.; Sudo, A. Advances in Platelet-Rich Plasma Treatment for Spinal Diseases: A Systematic Review. Int. J. Mol. Sci. 2023, 24,7677. https://doi.org/10.3390/ijms2408767731. S. Kim and B. Hwang, “Relationship between bone mineral density and the frequent administration of epidural steroid injections in postmenopausal women with low back pain,” Pain Research & Management, vol. 19, no. 1, pp. 30–34, 2014.32. T. Gosens, J. Peerbooms, W. van Laar, and B. den Oudsten, “Ongoing positive effect of platelet-rich plasma versus cortico- steroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up,” The American Journal of Sports Medicine, vol. 39, no. 6, pp. 1200–1208, 201
Refbacks
- There are currently no refbacks.







