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).
Highlights
Low back pain is one of the most difficult conditions to manage for doctors, patients, and policymakers
No statistically significant differences were found in visual analogue scale (VAS), pressure pain thresholds (PPTs), F-wave rates and latency, Oswestry disability index (ODI), and physical function (PF) and bodily pain (BP) domains of SF-36 between the two groups before operation (P > 0:05) (Table 1)
There was no significant difference in terms of VAS, PPTs, ODI, and the PF and BP domains of SF-36 in 1 week postoperation compared to corresponding basal values (median (1st-3rd quartiles); 6.0 (6.0-7.3) vs. 5.0 (5.0-6.0), P = 0:887; 580.60 kPa (557.92-601.01) vs. 625.96 kPa (571.53716.68), P = 0:087; 35.0% (26.4-44.0) vs. 27.0% (20.0-40.0), P = 0:125; 60.0 (45.0-70.0) vs. 75.0 (60.0-90.0), P = 0:284; 41.0 (31.0-51.0) vs. 43.0 (41.0-52.0), P = 0:794, respectively)
Summary
Low back pain is one of the most difficult conditions to manage for doctors, patients, and policymakers. Does it limit physical activity, life quality is greatly reduced alongside additional social and economic burden. The point prevalence of low back pain is 12%, with its one-year prevalence being 38% and the lifetime prevalence being approximately 40% [1]. Aging population leads to the rising number of individuals affected by low back pain. Lumbar disc herniation has been identified as the common etiology of low back pain [2]. The treatments for lumbar disc herniation vary from conservative to surgical management, which include analgesics, traction, physical therapy, manipulation, and psychotherapy. Not all patients are able to be relieved from pain through these treatments
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