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Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain

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Abstract

Introduction

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).

Methods

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.

Results

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.

Conclusion

The results of CT-guided interlaminar EPRPI are similar to ESI for the treatment of persistent LRP and could be a safer option.

Key Points

• 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.

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Fig. 1
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Abbreviations

6 W:

Six weeks follow-up

ACS:

Autologous conditioned serum

EPRPI:

Epidural platelet-rich plasma injection

ESI:

Epidural steroid injection

LRP:

Lumbar radicular pain

MRI:

Magnetic resonance imaging

NRS:

Numerical rating scale

NSAID:

Non-steroidal anti-inflammatory drugs

ODI:

Oswestry Disability Index

PRP:

Platelet-rich plasma

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Authors and Affiliations

  1. Centre d’imagerie ostéo-articulaire, Clinique du sport, 2 rue Georges-Negrevergne, 33700, Mérignac, France

    Sylvain Bise, Benjamin Dallaudiere, Lionel Pesquer, Philippe Meyer, Myriame Bou Antoun & Alain Silvestre

  2. Département d’imagerie musculo-squelettique, Centre hospitalier universitaire Pellegrin, place Amélie-Léon-Rabat, 33000, Bordeaux, France

    Benjamin Dallaudiere

  3. Centre aquitain du dos, Clinique du sport de Bordeaux, 2 rue Georges-Negrevergne, 33700, Mérignac, France

    Morad Pedram

  4. Service de radiologie et d’imagerie diagnostique et interventionnelle, CHU Vaudois, 1011, Lausanne, Switzerland

    Arnaud Hocquelet

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  1. Sylvain Bise
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Correspondence to Sylvain Bise.

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Bise, S., Dallaudiere, B., Pesquer, L. et al. Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain. Eur Radiol 30, 3152–3160 (2020). https://doi.org/10.1007/s00330-020-06733-9

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