Gupta Anuj, Chhabra Harvinder Singh, Singh Vishwajeet, Nagarjuna Daram
Department of Spine Surgery, Max Superspeciality Hospital, Ghaziabad, India.
Department of Spine Surgery, Sri Balaji Action Medical Institute, New Delhi, India.
Asian Spine J. 2024 Feb;18(1):58-65. doi: 10.31616/asj.2023.0115. Epub 2024 Feb 26.
Double-blind randomized controlled pilot study.
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.
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.
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.
Both groups were comparable in terms of demographics, preprocedure VAS scores, mODI, and SF-12 scores (p=0.52). At the 1-week follow-up, the steroid group had significantly better improvement than the PRP group (p=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, p<0.0001; ODI, p=0.02; SF-12, p=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.
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.
双盲随机对照试验性研究。
本研究旨在比较腰椎间孔注射（LTI）类固醇与自体富血小板血浆（PRP）治疗腰椎神经根病患者的疗效。
腰椎间盘退变疾病是脊柱外科医生日常诊疗中最常见的疾病之一。一旦保守治疗失败，LTI具有诊断作用且通常具有治疗作用。类固醇是用于LTI的金标准药物，但存在局限性和副作用。
在这项单中心双盲随机对照试验性研究中，通过抽签法招募了46例患者并进行随机分组。在第1周、第3周、第6周、6个月和1年时评估腿痛视觉模拟量表（VAS）、改良奥斯威斯利功能障碍指数（mODI）和简短健康调查问卷12项版（SF - 12）。
两组在人口统计学、术前VAS评分、mODI和SF - 12评分方面具有可比性（p = 0.52）。在1周随访时，类固醇组的改善明显优于PRP组（p = 0.0001）。在3周随访时，两组疗效相当；然而，PRP组的症状改善更好。在6周和6个月时，PRP组疗效更佳（VAS，p < 0.0001；ODI，p = 0.02；SF - 12，p = 0.002）。此外，类固醇组和PRP组分别有17例和16例患者因随访期间疼痛复发接受了类固醇重复LTI或手术。在1年时，未观察到疗效差异。
对于腰椎神经根病的LTI治疗，PRP可能是类固醇的一种有用替代方法。尽管改善延迟且1年疗效相当，但PRP在6周和6个月时的疗效优于LTI。由于PRP的自体性质，多次注射PRP可能有益。然而，需要更多参与者、更长随访时间和重复LTI的进一步研究才能得出明确结论。
