Platelet-rich Plasma Versus Steroid Injections for the Treatment of Lumbar Radicular Pain Due to Disc Herniation: A Systematic Review and Meta-analysis
Rashad G. Mohamed1, Khalid Sarhan2, Reem Reda Elmahdi1, Arwa Jader3, Mahmoud Hindawi4, Ahmed Negida5
1Mansoura Manchester Program for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt., 2Faculty of Medicine, Mansoura University, Mansoura, Egypt, 3Neurosurgery department, kufa university, kufa, Iraq, 4Faculty of Medicine, Al-Azhar University, Cairo, Egypt, 5Virginia Commonwealth University
Objective:
To compare the efficacy of Platelet-Rich Plasma vs. steroid Injections injections for treating lumbar radicular pain caused by disc herniation
Background:
Lumbar disc herniation is the most frequent cause of lumbar radicular pain (LRP) in adults between their 30s and 50s. Steroid injections are widely used for LRP but can carry rare, yet serious, complications. Recently, PRP has emerged as a potential alternative, promoting healing and reducing inflammation through the release of growth factors and cytokines.
Design/Methods:
Following PRISMA guidelines, we performed a comprehensive literature search across electronic databases to identify relevant studies up to October 2024. The primary outcome was the Visual Analogue Scale (VAS) pain score at 4, 6, 12, and 24 weeks. Secondary outcomes included functional improvement, assessed by the Oswestry Disability Index (ODI) at the same time intervals. Standardized mean difference (SMD) before and after treatment with 95% CIs were used for continuous variables.
Results:
Seven studies, including five randomized controlled trials (RCTs), one non-RCT, and one observational study, met the inclusion criteria. The meta-analysis revealed that PRP led to significantly greater improvements in VAS pain scores compared to steroid injections at all follow-up periods, except at 4 weeks, where no significant difference was observed [SMD (95% CI): 4 weeks: 0.42 (-0.32, 1.16), p < 0.27; 6 weeks: -0.81 (-1.60, -0.02), p < 0.05; 12 weeks: -0.74 (-1.40, -0.08), p < 0.03; 24 weeks: -1.00 (-1.88, -0.11), p < 0.03]. No significant differences in ODI were found between the groups, except at 24 weeks, where PRP showed a significant improvement [SMD (95% CI): -0.53 (-0.96, -0.10), p < 0.02].
Conclusions:
PRP injections appear safe and provide better pain control and functional outcomes at intermediate and long-term follow-ups compared to steroid injections for LRP caused by disc herniation.
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