Abstract
BackgroundEpidural steroid injections (ESI) are the most common pain management procedure performed in the US, however evidence of efficacy is limited. In addition, there is early evidence that the high dose of corticosteroids used can have systemic side effects. We describe the results of a case series evaluating the use of platelet lysate (PL) epidural injections for the treatment of lumbar radicular pain as an alternative to corticosteroids.MethodsRegistry data was obtained for patients (N = 470) treated with PL epidural injections presenting with symptoms of lumbar radicular pain and MRI findings that were consistent with symptoms. Collected outcomes included numeric pain score (NPS), functional rating index (FRI), and a modified single assessment numeric evaluation (SANE) rating.ResultsPatients treated with PL epidurals reported significantly lower (p < .0001) NPS and FRI change scores at all time points compared to baseline. Post-treatment FRI change score means exceeded the minimal clinically important difference beyond 1 month. Average modified SANE ratings showed 49.7% improvement at 24 months post-treatment. Twenty-nine (6.3%) patients reported mild adverse events related to treatment.ConclusionPatients treated with PL epidurals reported significant improvements in pain, exceeded the minimal clinically important difference (MCID) for FRI, and reported subjective improvement through 2-year follow-up. PL may be a promising substitute for corticosteroid.
Highlights
Epidural steroid injections (ESI) are the most common pain management procedure performed in the US, evidence of efficacy is limited
Self-reported modified single assessment numeric evaluation (SANE) rating above baseline was demonstrated in the majority of patients with data (>72%) treated with platelet lysate (PL) at every time point, which was sustained through the 24 month follow-up period
The significant difference in pain and function at later time points compared to scores at 1, 3, and even 6 months may suggest that a continued effect of the PL occurs over time
Summary
Epidural steroid injections (ESI) are the most common pain management procedure performed in the US, evidence of efficacy is limited. Lumbar epidural steroid injection (ESI) is a nonsurgical treatment for radicular pain and low back pain (LBP). ESIs are the most commonly performed pain management procedures for LBP and radiculopathy or radicular pain in the United States (Cohen 2011; Manchikanti 2004). Despite the popularity of the procedure with pain management specialists and other clinicians, there is no clear evidence demonstrating the efficacy of ESI as a means of improving function, decreasing disability, or reducing spine surgery rates (Airaksinen et al 2006; Armon et al 2007; Deyo et al 2009). A number of randomized placebo-controlled trials have concluded there is little difference in efficacy between ESI and placebo injections with saline (Deyo et al 2009; Centeno et al Journal of Experimental Orthopaedics (2017) 4:38
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