• Sylvain Bise, Benjamin Dallaudiere, Lionel Pesquer, Morad Pedram, Philippe Meyer, Antoun Myriame Bou MB Centre d'imagerie ostéo-articulaire, Clinique du sport, 2 rue Georges-Negrevergne, 33700, Mérignac, France., Arnaud Hocquelet, and Alain Silvestre.
• Centre d'imagerie ostéo-articulaire, Clinique du sport, 2 rue Georges-Negrevergne, 33700, Mérignac, France. sylvainbise@gmail.com.
• Eur Radiol. 2020 Jun 1; 30 (6): 3152-3160.

IntroductionThe treatment of persistent lumbar radicular pain (LRP) by CT-guided epidural steroid injection (ESI) is extensively used and associated with rare but serious complications. Platelet-rich plasma (PRP), which has recently been shown to favor healing and the anti-inflammatory process by delivering growth factors and cytokines, might be an alternative and potentially safer option. We compared the efficacy of interlaminar CT-guided epidural PRP injections (EPRPI) and ESI in the treatment of persistent LRP (> 6 weeks).MethodsIn this non-randomized comparative study, patients were prospectively assessed for pain using the numerical rating scale (NRS) and for function with the Oswestry Disability Index (ODI) before and 6 weeks after treatment. Related paired and independent t tests were used for intra- and inter-group comparisons.ResultsA total of 60 patients were included in 2 groups (n = 30 EPRPI, n = 30 ESI). A statistically significant improvement was found in both groups at 6 weeks (mean NRS values 5.7 (± 2.36) at D0 and 3.7 (± 2.3) at 6 weeks (p < 0.01); mean ODI values 30 (± 11) at D0 and 21 (± 13) at 6 weeks (p < 0.01)). No significant difference was observed in the decrease in NRS and ODI scores between the 2 groups at 6 weeks (p = 0.848 and p = 0.314 for the NRS and ODI, respectively). No major complications were noted.ConclusionThe results of CT-guided interlaminar EPRPI are similar to ESI for the treatment of persistent LRP and could be a safer option.Key Points• Treatment of persistent lumbar radicular pain by CT-guided epidural steroid injections is associated with rare but serious complications. • By promoting an anti-inflammatory process, epidural platelet-rich plasma injections might be an alternative treatment of persistent radicular pain. • Platelet-rich plasma CT-guided epidural injections are similar to steroid for the treatment of lumbar radicular pain at 6 weeks post-procedure and could be a safer option.

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