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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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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.

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
Fig. 2
Fig. 3


6 W:

Six weeks follow-up


Autologous conditioned serum


Epidural platelet-rich plasma injection


Epidural steroid injection


Lumbar radicular pain


Magnetic resonance imaging


Numerical rating scale


Non-steroidal anti-inflammatory drugs


Oswestry Disability Index


Platelet-rich plasma


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Correspondence to Sylvain Bise.

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The scientific guarantor of this publication is Dr. Alain Silvestre.

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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).

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