Muthu Sathish, Viswanathan Vibhu Krishnan, Gangadaran Prakash
Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, India.
Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, India.
Exp Biol Med (Maywood). 2025 Feb 4;250:10390. doi: 10.3389/ebm.2025.10390. eCollection 2025.
The current meta-analysis was performed to analyze the efficacy and safety of platelet-rich plasma (PRP) as an epidural injectate, in comparison with steroids in the management of radiculopathy due to lumbar disc disease (LDD). We conducted independent and duplicate searches of the electronic databases (PubMed, Embase and Cochrane Library) in March 2024 to identify randomized controlled trials (RCTs) analyzing the efficacy of epidural PRP for pain relief in the management of LDD. Animal or studies, clinical studies without a comparator group, and retrospective or non-randomised clinical studies were excluded. Diverse post-intervention pain scores [visual analog score (VAS)] and functional scores [Oswestry Disability Index (ODI), SF-36], as reported in the reviewed studies, were evaluated. Statistical analysis was performed using STATA 17 software. 5 RCTs including 310 patients (PRP/Steroids = 153/157) were included in the analysis. The included studies compared the efficacy and safety of epidural PRP and steroids at various time-points including 1, 3, 6, 12, 24, and 48 weeks. Epidural PRP injection was found to offer comparable pain relief (VAS; WMD = -0.09, 95% CI [-0.66, 0.47], p = 0.641; I = 96.72%, p < 0.001), functional improvement (ODI; WMD = 0.72, 95% CI [-6.81, 8.25], p = 0.524; I = 98.73%, p < 0.001), and overall health improvement (SF-36; WMD = 1.01, 95% CI [-1.14, 3.17], p = 0.224; I = 0.0%, p = 0.36) as epidural steroid injection (ESI) at all the observed time points in the included studies without any increase in adverse events or complications. Epidural administration of PRP offers comparable benefit as epidural steroid injection (ESI) in the management of radiculopathy due to LDD. The safety profile of the epidural PRP is also similar to ESI.
本荟萃分析旨在比较富血小板血浆（PRP）作为硬膜外注射剂与类固醇在治疗腰椎间盘疾病（LDD）所致神经根病中的疗效和安全性。2024年3月，我们对电子数据库（PubMed、Embase和Cochrane图书馆）进行了独立且重复的检索，以确定分析硬膜外PRP在LDD治疗中缓解疼痛疗效的随机对照试验（RCT）。排除动物研究、无对照组的临床研究以及回顾性或非随机临床研究。对纳入研究中报告的不同干预后疼痛评分[视觉模拟评分（VAS）]和功能评分[Oswestry功能障碍指数（ODI）、SF - 36]进行评估。使用STATA 17软件进行统计分析。分析纳入了5项RCT，共310例患者（PRP/类固醇 = 153/157）。纳入研究在包括1、3、6、12、24和48周的不同时间点比较了硬膜外PRP和类固醇的疗效和安全性。结果发现，在纳入研究的所有观察时间点，硬膜外注射PRP在缓解疼痛（VAS；加权均数差[WMD] = -0.09，95%可信区间[-0.66, 0.47]，p = 0.641；I² = 96.72%，p < 0.001）、功能改善（ODI；WMD = 0.72，95%可信区间[-6.81, 8.25]，p = 0.524；I² = 98.73%，p < 0.001）以及整体健康改善（SF - 36；WMD = 1.01，95%可信区间[-1.14, 3.17]，p = 0.224；I² = 0.0%，p = 0.36）方面与硬膜外类固醇注射（ESI）相当，且不良事件或并发症未增加。在治疗LDD所致神经根病方面，硬膜外注射PRP与硬膜外类固醇注射（ESI）的益处相当。硬膜外PRP的安全性也与ESI相似。
