Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study

Study design: Prospective randomized clinical study. Purpose: To compare the effectiveness and safety of intra-articular platelet-rich plasma (PCP) and steroid along with radiofrequency ablation (RFA) in the treatment of chronic low back pain (LBP) due to facet joint arthropathy. Overview of literature: Facet joint pathology is an important cause of LBP-15-30% of all LBP cases. Lumbar intra-articular PRP is a relatively new method in the treatment of LBP. PRP stimulates the cells involved in regeneration. Hence, it seems a suitable option for the treatment of lumbar facet joint syndrome. Methods: We evaluated the efficacy and safety of facet joint injections in LBP secondary to facet joint arthropathy. Chronic LBP for >= 3 months (visual analogue scale (VAS) > 4), failed conservative treatment, no neurological deficit, unilateral facet joint pain, focal tenderness with hyperextension pain, and relief by diagnostic medial branch block were included. Patients were randomly allocated to Group S: Steroid (Triamcinolone) + RFA or Group P: PRP + RFA or Group R: 0.9% saline + RFA as control. Demographic, clinico-radiological, and outcome parameters were recorded till 6 months. Data were analyzed using SPSS and p < 0.05 was considered significant. Results: We studied 45 patients (n = 15 in each group) in the final analysis. Mean age was 45.7 +/- 13.6 years and 60% were females in all groups. VAS decreased to 1.6 +/- 0.8 (Group S) and 3.2 +/- 0.8 (Group P) on day 1 (p < 0.05). At 3 and 6 months, VAS reduced more in Group P (0.47 +/- 0.5; 0.07 +/- 0.2) versus Group S (2.53 +/- 0.5; 3.07 +/- 0.2) (p < 0.001). Mean Oswestry Disability Index (ODI) score at baseline was 72.8 +/- 7.6 (all groups). At 1 month, Group S (17.2 +/- 3.2) showed better improvement than Group P (23.2 +/- 3.1) (p < 0.05). At 6 months, Group P (8.9 +/- 1.2) had more decrease in ODI than Group S (29.0 +/- 2.1) (p < 0.001). NSAIDs usage and Patient Satisfaction Score (PSS) were significantly better at 6 months in Group P than Group S (p < 0.01; p < 0.05, respectively). Conclusion: Both PRP and corticosteroid injections were determined to be effective and safe for the treatment of lumbar facet joint syndrome after 6 months of follow-up. However, autologous PRP may be a superior treatment option for longer efficacy.