Platelet Rich Plasma and Platelet-Related Products in the Treatment of Radiculopathy—A Systematic Review of the Literature

Abstract

Back pain with radicular symptoms is associated with detrimental physical and emotional functioning and economic burden. Conservative treatments including physical, pharmacologic and injection therapy may not provide clinically significant or long-standing relief. Regenerative medicine research including Platelet rich plasma (PRP), Platelet lysate (PL) or Plasma rich in growth factors (PRGF) continues to develop, however evidence appraisal for treatment of radicular pain remains lacking. Thus, we performed a systematic review to evaluate the effectiveness of epidural steroid injections containing PRP or related products to treat radicular pain. Embase, PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were queried. Twelve studies were included in qualitative analysis, consisting of three randomized controlled trials and nine observational studies. The primary outcome was pain intensity, and secondary outcomes included functional improvement, anatomical changes on advanced imaging, and adverse events. All studies identified improved pain intensity and functional outcomes after epidural injection of PRP, PRGF and/or PL. Similar or longer lasting pain relief was noted in the PRP cohort compared to the cohort receiving epidural steroid injections with effects lasting up to 12–24 months. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis revealed a very-low certainty of evidence due to risk of bias, indirectness, and imprecision.

Percutaneous bone marrow concentrate and platelet products versus exercise therapy for the treatment of rotator cuff tears: a randomized controlled, crossover trial with 2-year follow-up

“…BMC injections have demonstrated encouraging results when utilized in the treatment of some types of RC injury without surgical intervention [ 18 – 21 ]. PRP, meanwhile, has demonstrated early evidence of efficacy in augmenting surgical repair as well as treating painful tendinopathy [ 22 , 23 ], while PL has shown promise in treating radicular pain [ 24 ]. Although exact mechanisms of action are unclear, BMC and PRP likely utilize cellular signaling via cytokines and growth factors to help orchestrate a healing cascade [ 25 – 27 ].…”

Injections of Platelet-Rich Plasma: An Emerging Novel Biological Cure for Low Back Pain?

“…Most of the time, there are multiple contributing factors to LBP, including facet joints, spinal ligaments, the vertebral periosteum, the central cord, and spinal nerve roots. Radicular pain symptoms can be caused by pressure on the spinal nerve roots due to compression or inflammation of the spinal nerve roots leaving the spine; this is typically the case when there are spondylotic changes in the spine or disc herniation [ 2 ]. The problem at hand is complicated, and its effects on the global economy are enormous.…”

Optimizing Platelet-Rich Plasma: Spin Time and Sample Source

“…While first promulgated in veterinary science and dentistry [7], its use spread rapidly to trauma surgery [8], orthopedics [9], plastic surgery [10], urology [11], ophthalmology [12], dermatology [13], regenerative medicine [14,15] and other specialties. Innovative new uses for PRP, such as in neurology [16,17], are being reported almost daily, and it appears that much of the progress in regenerative medicine is due to PRP.…”