COMPARATIVE STUDY OF FLUOROSCOPY GUIDED TRANSFORAMINAL PLATELET RICH PLASMA VERSUS CORTICOSTEROID INJECTION FOR LUMBAR DISC HERNIATION RADICULOPATHY

Abstract

Background Surgeons frequently encounter a substantial number of patients who exhibit symptoms indicative of lumbar disc herniation radiculopathy. When comparing newer injection therapies, steroids, which are one of the most used injectable medications, seem to be the most reliable and universally accepted option. Several clinical trials have demonstrated the effectiveness of platelet rich plasma (PRP) injections, which possess anti-inflammatory and healing qualities, as a treatment for this problem. Objective To compare the functional efficacy of platelet rich plasma (PRP) versus corticosteroid (CS) injection in lumbar disc herniation radiculopathy when these injections were administered via transforaminal route under the guidance of fluoroscopy. Methodology All patients diagnosed with lumbar disc herniation radiculopathy from September 2022 to December 2023 and admitted to the Orthopaedics department of RL Jalappa hospital in Kolar were taken up in the study. After a patient meets all inclusion and exclusion criteria, they had a thorough evaluation consisting of a medical history, physical exam, and imaging tests. xvi The 96 patients were split into two groups, Group A and Group B, equally. Following the acquisition of permission and surgical fitness, patients were administered PRP to group A via transforaminal injection and corticosteroids to group B. During the follow-up of 6 months, each patient was evaluated using the Modified Oswestry low back pain Disability Index (MODI), Visual Analog Scale (VAS), Modified Roland Morris sciatica score (MRM), and Core Measures Index (COMI). Results The mean age of the lumbar disc herniation radiculopathy (LDHR) patients in PRP group was 40.75 ± 10.8 years and the mean age of the LDHR patients in CS group was 43.52 ± 8.9 years. About 54.2% of the LDHR patients were male in PRP group, and the remaining 45.2% were female. Similarly, 52.1% of the LDHR patients were male in steroid group, and the remaining 47.9% were female. In the treatment of LDHR patients, there was a consistent decline in VAS score after PRP and Steroid injection. Based on the findings it was inferred that PRP was better than Steroid in reducing perceived pain (VAS) at long term (6 months), whereas steroid was better than PRP in reducing perceived pain at short term (1 and 3 months). xvii In the treatment of LDHR patients, there was a consistent reduction in MODI disability score after PRP and steroid injection. Based on the findings it was inferred that PRP was better than Steroid in reducing disability (MODI) in the long term (3 and 6 months), whereas steroid was better than PRP in reducing disability at short term (1 month). In the study LDHR patients, there was a consistent reduction in COMI outcome score after PRP and steroid injection. Based on the findings it was inferred that PRP was better than Steroid in improving outcome (COMI) at long term (6 months), whereas steroid was better than PRP in improving outcome at short term (1 and 3 months). But it didn’t have any statistically significant. Hence there existed no difference in outcome (measured by COMI) between the PRP and Steroid groups after the injection. In the treatment of LDHR patients, there was a consistent increase in MRM pain related disability score after PRP and steroid injection. Based on the findings it was inferred that PRP was superior than Steroid in MRM (reducing pain related disability) at long term (6 months), whereas steroid was superior to PRP in MRM (reducing pain related disability) at short term (1 and 3 months). xviii Conclusion The results of the trial showed that CS and PRP were equally effective at reducing pain and functional impairment. However, the PRP group had a more pronounced and enduring decrease in pain intensity and enhancement in functional impairment compared to the steroid group in long term follow up.