Epidural Platelet-Rich Plasma Long-Term Outcome Is Better Than Steroid for Prolapsed Lumbar Intervertebral Discs: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Prolapsed lumbar intervertebral disc (IVD) is a prevalent spinal cause of low back pain associated with radicular pain. Platelet-rich plasma (PRP) has emerged as a potential alternative to epidural steroid injections. This review aimed to compare the efficacy of epidural PRP and epidural steroid injections in treating low back pain due to prolapsed lumbar IVD, assessed using a pain scale and Oswestry's disability index (ODI).

METHODS

A systematic search of 4 databases (PubMed, Scopus, ScienceDirect, and Cochrane Central Register of Controlled Trials) up to July 2024 for randomized controlled trials comparing epidural PRP with steroids. Risk of Bias 2 was used for bias assessment. Pain and ODI mean differences (MDs) were calculated using RevMan v5.4. Heterogeneity was measured using I2, with random or fixed effects applied accordingly. The combined outcome progression of pain and ODI scores were computed using STATA/MP 17.0 software.

RESULTS

Three trials (n=132) were included. At 1 month, epidural steroid injections showed lower pain scores than PRP (standard MD=1.04, 95% confidence interval [CI]: 0.63-1.46, p<0.00001, I2=0%). At 6 months, epidural PRP injection demonstrated greater pain relief (MD=-1.51, 95% CI: -1.98 to -1.05, p<0.00001, I2=0%) and lower ODI (MD=-9.71, 95% CI: -16.63 to -2.78, p=0.006, I2=75%). Epidural steroids showed significant worsening in pain score (1 vs 3 months, p=0.001; 3 vs 6 months, p=0.003).

CONCLUSIONS

Epidural PRP provides sustained and gradual improvement of pain and ODI for patients with prolapsed lumbar IVD over months of follow-up, while steroids provide initial relief at 1 month but are associated with worsening at later follow-ups.