Machado Edilson Silva, Soares Fabiano Pasqualotto, Vianna de Abreu Ernani, de Souza Taís Amara da Costa, Meves Robert, Grohs Hans, Ambach Mary A, Navani Annu, de Castro Renato Bevillaqua, Pozza Daniel Humberto, Caldas José Manuel Peixoto
REGENERAR-Pain Medical Center, Porto Alegre 90620-130, Brazil.
PhD (c) Faculty of Medicine, University of Porto, 4200-135 Porto, Portugal.
Biomedicines. 2023 Aug 28;11(9):2404. doi: 10.3390/biomedicines11092404.
Low back pain (LBP) has a high economic burden and is strongly related to the degenerative process of the spine, especially in the intervertebral disc and of the facet joints. Numerous treatment modalities have been proposed for the management of LBP, and the use of platelet-rich plasma (PRP) has emerged as an innovative therapeutic option for degenerative disease of the spine. The present study aims to evaluate the efficacy of PRP injections in managing low back pain.
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a registered at PROSPERO Systematic Reviews Platform, under number CRD42021268491. The PubMed, Web of Science, and Scopus databases were searched to identify relevant articles, along with hand searching to identify gray literature articles, with no language restrictions. Randomized clinical trials (RCTs), nonrandomized trials (NRTs), and case series (CSs) with more than 10 patients were considered eligible. The quality assessment and the risk of bias of the randomized clinical trials were evaluated using the RoB II tool. An evaluation of the description of the preparation methods was performed using an adapted version of the MIBO checklist.
An electronic database search resulted in 2324 articles, and after the exclusion of noneligible articles, 13 RCTs and 27 NRTs or CSs were analyzed. Of the 13 RCTs, 11 found favorable results in comparison to the control group in pain and disability, one showed no superiority to the control group, and one was discontinued because of the lack of therapeutic effect at eight-week evaluation. Description of the PRP preparation techniques were found in almost all papers. The overall risk of bias was considered high in 2 papers and low in 11. An adapted MIBO checklist showed a 72.7% compliance rate in the selected areas.
In this systematic review, we analyzed articles from English, Spanish and Russian language, from large databases and grey literature. PRP was in general an effective and safe treatment for degenerative LPB. Positive results were found in almost studies, a small number of adverse events were related, the risk of bias of the RCTs was low. Based on the evaluation of the included studies, we graded as level II the quality of the evidence supporting the use of PRP in LBP. Large-scale, multicenter RCTs are still needed to confirm these findings.
腰痛（LBP）具有较高的经济负担，且与脊柱退变过程密切相关，尤其是椎间盘和小关节的退变。针对腰痛的管理已提出了多种治疗方式，富血小板血浆（PRP）的应用已成为脊柱退行性疾病的一种创新治疗选择。本研究旨在评估PRP注射治疗腰痛的疗效。
我们按照系统评价和Meta分析的首选报告项目（PRISMA）建议进行了一项系统评价，该评价在PROSPERO系统评价平台注册，注册号为CRD42021268491。检索了PubMed、科学网和Scopus数据库以识别相关文章，并通过手工检索识别灰色文献文章，无语言限制。纳入标准为随机临床试验（RCT）、非随机试验（NRT）以及患者数超过10例的病例系列（CS）。使用RoB II工具评估随机临床试验的质量和偏倚风险。使用MIBO清单的改编版本对制备方法的描述进行评估。
电子数据库检索得到2324篇文章，排除不符合标准的文章后，分析了13项RCT以及27项NRT或CS。在13项RCT中，11项在疼痛和功能障碍方面与对照组相比取得了良好结果，1项显示不比对照组优越，1项因在8周评估时缺乏治疗效果而中止。几乎所有论文都对PRP制备技术进行了描述。2篇论文的总体偏倚风险被认为较高，11篇较低。改编后的MIBO清单显示所选领域的符合率为72.7%。
在本系统评价中，我们分析了来自英语、西班牙语和俄语的文章，涵盖大型数据库和灰色文献。PRP总体上是治疗退行性LBP的一种有效且安全的治疗方法。几乎所有研究都取得了阳性结果，相关的不良事件数量较少，RCT的偏倚风险较低。基于对纳入研究的评估，我们将支持在LBP中使用PRP的证据质量评为II级。仍需要大规模、多中心的RCT来证实这些发现。
