Centre d'imagerie ostéo-articulaire, Clinique du sport, 2 rue Georges-Negrevergne, 33700, Mérignac, France.
Département d'imagerie musculo-squelettique, Centre hospitalier universitaire Pellegrin, place Amélie-Léon-Rabat, 33000, Bordeaux, France.
Eur Radiol. 2020 Jun;30(6):3152-3160. doi: 10.1007/s00330-020-06733-9. Epub 2020 Feb 24.
The treatment of persistent lumbar radicular pain (LRP) by CT-guided epidural steroid injection (ESI) is extensively used and associated with rare but serious complications. Platelet-rich plasma (PRP), which has recently been shown to favor healing and the anti-inflammatory process by delivering growth factors and cytokines, might be an alternative and potentially safer option. We compared the efficacy of interlaminar CT-guided epidural PRP injections (EPRPI) and ESI in the treatment of persistent LRP (> 6 weeks).
In this non-randomized comparative study, patients were prospectively assessed for pain using the numerical rating scale (NRS) and for function with the Oswestry Disability Index (ODI) before and 6 weeks after treatment. Related paired and independent t tests were used for intra- and inter-group comparisons.
A total of 60 patients were included in 2 groups (n = 30 EPRPI, n = 30 ESI). A statistically significant improvement was found in both groups at 6 weeks (mean NRS values 5.7 (± 2.36) at D0 and 3.7 (± 2.3) at 6 weeks (p < 0.01); mean ODI values 30 (± 11) at D0 and 21 (± 13) at 6 weeks (p < 0.01)). No significant difference was observed in the decrease in NRS and ODI scores between the 2 groups at 6 weeks (p = 0.848 and p = 0.314 for the NRS and ODI, respectively). No major complications were noted.
The results of CT-guided interlaminar EPRPI are similar to ESI for the treatment of persistent LRP and could be a safer option.
• Treatment of persistent lumbar radicular pain by CT-guided epidural steroid injections is associated with rare but serious complications. • By promoting an anti-inflammatory process, epidural platelet-rich plasma injections might be an alternative treatment of persistent radicular pain. • Platelet-rich plasma CT-guided epidural injections are similar to steroid for the treatment of lumbar radicular pain at 6 weeks post-procedure and could be a safer option.
CT 引导下硬膜外类固醇注射（ESI）治疗持续性腰椎根性疼痛（LRP）应用广泛，但也存在罕见但严重的并发症。富含血小板的血浆（PRP）最近被证明可以通过输送生长因子和细胞因子来促进愈合和抗炎过程，可能是一种替代方案，且具有潜在的安全性。我们比较了经皮椎间孔 CT 引导下硬膜外富血小板血浆注射（EPRPI）和 ESI 治疗持续性 LRP（>6 周）的疗效。
这是一项非随机对照研究，前瞻性评估了疼痛（使用数字评分量表（NRS））和功能（使用 Oswestry 残疾指数（ODI）），分别在治疗前和治疗后 6 周进行。采用配对和独立 t 检验进行组内和组间比较。
共纳入 60 例患者，分为 2 组（EPRPI 组 30 例，ESI 组 30 例）。两组在 6 周时均有显著改善（NRS 评分均值分别为 5.7（±2.36）和 3.7（±2.3），p<0.01；ODI 评分均值分别为 30（±11）和 21（±13），p<0.01）。两组治疗后 6 周 NRS 和 ODI 评分下降无显著差异（NRS：p=0.848；ODI：p=0.314）。未发现严重并发症。
CT 引导下椎间孔 EPRPI 治疗持续性 LRP 的效果与 ESI 相似，且可能是一种更安全的选择。
• CT 引导下硬膜外类固醇注射治疗持续性腰椎根性疼痛，虽罕见但严重的并发症。
• 通过促进抗炎过程，硬膜外富血小板血浆注射可能是治疗持续性神经根痛的一种替代方法。
• 富血小板血浆 CT 引导下硬膜外注射与甾体类药物治疗腰椎根性疼痛在 6 周后效果相当，且可能是一种更安全的选择。
