Therapeutic interventions of platelet-rich plasma versus corticosteroid injections for lumbar radicular pain: a systematic review and meta-analysis.

IF 2.8 3区医学 Q1 ORTHOPEDICS

Journal of Orthopaedic Surgery and Research Pub Date : 2025-03-25 DOI:10.1186/s13018-025-05725-z

Xinan Wang, Ying Zhang

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引用次数: 0

Abstract

Objective: Although epidural corticosteroid injections (ESIs) provide short-term relief for lumbar radicular pain caused by disc herniation, concerns remain regarding their long-term efficacy and complications. Platelet-rich plasma (PRP), with its dual anti-inflammatory and regenerative properties, is a promising alternative, but the comparative evidence between the two treatments remains inconclusive.

Methods: A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, with a cutoff date of January 10, 2025. The primary outcomes were the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The risk of bias in the included studies was assessed using Cochrane ROB and ROBINS-I. The primary outcome measures were analyzed by evaluating standardized mean differences (SMDs).

Results: A total of seven studies (four randomized controlled trials and three prospective studies) were included in the meta-analysis, comprising 416 patients. The results indicated that corticosteroids significantly reduced ODI scores at the initial follow-up (4 weeks) (SMD = 0.48, 95% CI: 0.20 to 0.75, p = 0.0008, I² = 15%), with no significant differences observed in VAS and ODI scores between the two groups at other time points. The complication rates for the PRP and corticosteroid groups were reported, with no severe adverse events reported.

Conclusions: Compared to PRP, corticosteroid injections showed significant early functional improvements in patients. Although no significant differences in pain and functional improvements were observed between the PRP and corticosteroid groups at other follow-up time points, future studies are needed to assess the efficacy and safety of PRP versus corticosteroid injections in treating lumbar radicular pain by standardizing PRP preparation, extending follow-up durations, and increasing sample sizes.

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富血小板血浆与皮质类固醇注射治疗腰根性疼痛的干预措施：系统回顾和荟萃分析。

目的：尽管硬膜外皮质类固醇注射（ESIs）可以短期缓解腰椎间盘突出症引起的腰根性疼痛，但其长期疗效和并发症仍然值得关注。富血小板血浆（PRP）具有抗炎和再生的双重特性，是一种很有前途的替代疗法，但两种治疗方法之间的比较证据仍不确定。方法：系统检索PubMed、Embase、Web of Science和Cochrane Library，截止日期为2025年1月10日。主要结果为视觉模拟量表（VAS）和Oswestry残疾指数（ODI）评分。纳入研究的偏倚风险采用Cochrane ROB和ROBINS-I进行评估。通过评估标准化平均差异（SMDs）来分析主要结局指标。结果：meta分析共纳入7项研究（4项随机对照试验和3项前瞻性研究），共纳入416例患者。结果显示，糖皮质激素在初始随访（4周）时显著降低ODI评分（SMD = 0.48, 95% CI: 0.20 ~ 0.75, p = 0.0008, I²= 15%），两组在其他时间点的VAS和ODI评分无显著差异。报告了PRP组和皮质类固醇组的并发症发生率，无严重不良事件报告。结论：与PRP相比，皮质类固醇注射对患者的早期功能有显著改善。尽管在其他随访时间点PRP组和皮质类固醇组在疼痛和功能改善方面没有观察到显著差异，但未来的研究需要通过标准化PRP制备、延长随访时间和增加样本量来评估PRP与皮质类固醇注射治疗腰根性疼痛的有效性和安全性。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.