Platelet Rich Plasma for the Therapy of the Lumbar Facet Joint Syndrome: A Prospective Study About CT-Guided Facet Joint Injections With PRP Compared to Local Anesthetics.

Abstract

Objective: To investigate the clinical effects of Leukocyte-poor-Platelet-Rich-Plasma (LpPRP) injections to treat chronic facet joint syndrome.

Methods: 78 patients suffering from chronic facet joint syndrome at the Center for Molecular Orthopedics (CMO) agreed to participate to this prospective controlled study to receiving a series of CT-guided PAT-injections (periarticular therapy) to lumbar facet joints. The patients were free to decide to receive either injections based on Platelet-Rich-Plasma (PRP) or local anesthetics (LA/bupivacaine). In this study leucocyte-poor PRP (LpPRP) was used for all patients of the verum group, namely autologous conditioned plasma (Arthrex ACP® / Arthrex Inc., Naples, FL, USA) as the verum group. 59 patients were treated 3-5 times in at least two levels of facet joints in the PRP group, 19 patients decided to join the LA group receiving local anesthetics (LA group) each in a weekly interval. All patients agreed to answer an automated email questionnaire for up to one year starting at baseline before receiving the first injections. The follow up protocol was based on a pain scale, and the Oswestry disability score. Data analysis was evaluated using the Excel analysis tools.

Results: Data analysis revealed that both, PRP and local anesthetics had a pain reducing effect initially at week 2 after receiving the first PAT, but from week six on up to one year post injection, PRP infiltrations were superior with a significantly reduced pain score compared to baseline up to one year (p<0.001). Oswestry score showed similar results with a significant improvement to about one half compared to baseline (p<0.001) up to six months, still being significantly better at one year (p<0.01). The comparison of the PRP group to the LA group showed a better pain relief and better values at the Oswestry disability score between three and six months and one year.

Conclusions: We show that a CT-guided injection therapy (PAT) based on LpPRP addressing the facet joint mediated low back pain syndrome leads to a significant long term pain reduction, and to a significant improvement in the Oswestry disability score for at least one year.