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 (<i>p</i>=0.52). At the 1-week follow-up, the steroid group had significantly better improvement than the PRP group (<i>p</i>=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, <i>p</i><0.0001; ODI, <i>p</i>=0.02; SF-12, <i>p</i>=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.

Evolving Spinal Treatment Modalities: A Review of the Literature on Non-surgical Interferential Differential Dynamics (IDD) Therapy

“…The indications of surgical management are limited to neurological deficits and intractable pain [12]. There are different modalities of conservative management, which include prescribing medication, transforaminal injection [13], massage, bracing, and physical therapy. Every physician has a different means or combination of administering modalities for treating patients depending on their subjective experience.…”

Letter to the Editor: Lumbar transforaminal injection of steroids versus platelet-rich plasma for prolapse lumbar intervertebral disc with radiculopathy: a randomized double-blind controlled pilot study

“…We read the article entitled “Lumbar transformation injection of steroids versus platelet-rich plasma for prolapse lumbar intervertebral disc with radiculopathy: a randomized double-blind controlled pilot study” by Gupta et al [ 1 ] with interest. However, we would like to comment on its content and statistical analysis reported.…”

Response to the Letter to the Editor: Lumbar transforaminal injection of steroids versus platelet-rich plasma for prolapse lumbar intervertebral disc with radiculopathy: a randomized double-blind controlled pilot study

“…We want to thank the authors of the “Letter to the Editor” for their interest in our pilot study [ 1 ], which compared lumbar transforaminal injection of steroids and platelet-rich plasma for patients with prolapsed lumbar intervertebral disc with radiculopathy in a randomized double-blind controlled trial. We appreciate and welcome their comments and would like to address them in this forum.…”

“…We also acknowledge that the sampling method employed was convenience sampling, and every consecutive lumbar disc herniation patient had an opportunity to be enrolled in the study. The underlying data distribution was tested for normality using mean and standard deviation as described in the data in Table 1 of our study [ 1 ]. We did not use any software for the pilot study but data was analyzed with appropriate parameters to justify the use of mentioned test.…”