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

Abstract

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.

Keywords

• Platelet-rich plasma
• Corticosteroid
• Lumbar radicular pain
• Clinical efficacy
• Therapeutic intervention
• Meta-analysis