Lumbar Transforaminal Injection of Steroids versus Platelet-Rich Plasma for Prolapse Lumbar Intervertebral Disc with Radiculopathy: A Randomized Double-Blind Controlled Pilot Study

Abstract

Study design: Double-blind randomized controlled pilot study.

Purpose: The purpose of this study was to compare outcomes of steroids with autologous platelet-rich plasma (PRP) administered by lumbar transforaminal injection (LTI) in patients with lumbar radiculopathy.

Overview of literature: Degenerative disc disease of the lumbar spine is one of the most common conditions managed by spine surgeons in routine practice. Once conservative management fails, LTI is diagnostic and often therapeutic. Steroids are the gold standard drug used for LTI but have limitations and side effects.

Methods: In this single-center double-blind randomized controlled pilot study, 46 patients were recruited and randomized by the lottery method. The Visual Analog Scale (VAS) for leg pain, modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) were assessed at 1 week, 3 weeks, 6 weeks, 6 months, and 1 year.

Results: Both groups were comparable in terms of demographics, preprocedure VAS scores, mODI, and SF-12 scores (p=0.52). At the 1-week follow-up, the steroid group had significantly better improvement than the PRP group (p=0.0001). At the 3-week follow-up, both groups showed comparable outcomes; however, the PRP group had better symptom improvement. At 6 weeks and 6 months, the PRP group had better outcomes (VAS, p<0.0001; ODI, p=0.02; SF-12, p=0.002). Moreover, 17 and 16 patients in the steroid and PRP groups underwent repeat LTI with steroids or surgery because of pain recurrence during follow-up. At 1 year, no difference in outcomes was observed.

Conclusions: PRP may be a useful alternative to steroids for LTI in lumbar radiculopathy. Although improvement was delayed and 1-year outcomes were comparable, the 6-week and 6-month outcomes were better with PRP than with LTI. Multiple PRP injections may be beneficial because of its autologous nature. However, further studies with a larger number of participants, longer follow-up, and repeat LTIs are warranted to draw definite conclusions.

Keywords: Intervertebral disc herniation; Lumbar transforaminal injection; Platelet-rich plasma; Radiculopathy; Steroids.

Fig. 1.

Platelet-rich plasma (PRP) preparation. (A) Collection of blood from the patient. (B) Insertion of collected blood in PRP kit. (C) Kit insertion in Harvest Smart prep. (D) Final PRP formed.

Fig. 2.

C-arm images showing lumbar transforaminal injection technique. (A) Scotty-dog view with 22G spinal needle targeting the foramen. (B) Anteroposterior view with radiculogram. (C) Lateral view showing position of spinal needle and radiculogram.

Fig. 3.

Pre-injection mean Visual Analog Scale (VAS), modified Oswestry Disability Index (mODI) and Short-Form 12 (SF-12) scores of steroids and plateletrich plasma (PRP) groups showing that both the groups were comparable.

Fig. 4.

Visual Analog Scale (VAS), modified Oswestry Disability Index (mODI), and mean Short-Form 12 (SF-12) scores of steroids and platelet-rich plasma (PRP) groups at the 1-week follow-up.

Fig. 5.

Visual Analog Scale (VAS), modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) scores of platelet-rich plasma (PRP) and steroid groups at the 3-week follow-up.

Fig. 6.

Mean Visual Analog Scale (VAS), modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) scores of platelet-rich plasma (PRP) and steroid groups at the 6-week follow-up.

Fig. 7.

Progress of mean Visual Analog Scale (VAS), modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) scores of steroid groups from 1 week to 6 weeks.

Fig. 8.

Progress of mean Visual Analog Scale (VAS), modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) scores in platelet-rich plasma (PRP) group from 1 week to 6 weeks.