A PROSPECTIVE COMPARATIVE STUDY OF FLUOROSCOPIC GUIDED SINGLE INTRA ARTICULAR INJECTION OF AUTOLOGOUS PLATELET RICH PLASMA VERSUS CORTICOSTEROID IN DEGENERATIVE FACET JOINT SYNDROME A RANDOMISED CONTROL TRIAL

Abstract

Background Lumbar facet joint (LFJ) therapies are beneficial for detection and management of persistent low back pain (LBP), including degenerative facet joint syndrome (DFJS). These procedures require intra-articular (IA) injections of drugs using various techniques. IA facet joint (FJ) injection has been demonstrated to be effectual in the management of facetogenic pain in previous researches. The direct administration of steroids into the joint has been shown to have a variety of adverse effects. Platelet-rich plasma (PRP) is advantageous because of its cost-effectiveness, autologous properties, minimal invasiveness, and ease of acquisition and preparation. Consequently, PRP does not show the negative side effects that are commonly associated with other frequently used medications. Aim and Objective To analyse the functional outcome of a single injection of autologous IA PRP compared to single injection of IA corticosteroid (CS). This study strived to analyse the short-term and long-term effectiveness of both treatments in the management of DFJS. xv Methodology All consecutive patients who were diagnosed with DFJS between September 2022 and May 2023 and were admitted to the Orthopaedics department at R.L. Jalappa hospital, Kolar. A computer online random generator software was used to randomly allot the sample of 74 cases into two groups, with 37 in each group. Group A patients received IA PRP injection, while patients in Group B received IA CS injection. Patients were monitored at 4 weeks, 8 weeks, 12 weeks, 6 months and 1 year after receiving an IA injection. During the follow-up, each patient was evaluated using several assessment tools, including the Visual Analog Scale (VAS), Present Pain Index (PPI), Modified Oswestry low back pain Disability Index (MODI), Roland-Morris Questionnaire (RMQ), and Short Form Health Score-12 (SF-12). Results There is a significant decrease in pain in both the groups. PRP is better than steroid in reducing perceived pain, improving disability and quality of life (QOL) in the long term (1 year). Steroid is better than PRP in reducing perceived pain, improving disability and QOL at short term, though not found to be statistically significant (1 month to 6 months). xvi Conclusion An ideal new injectable medicine for treating DFJS is autologous PRP. Both PRP and steroid injections were easy, effective, and safe enough to use for treating LFJ conditions after one year of follow-up. Both groups saw a substantial reduction in pain and impairment, which was assessed using the VAS, MODI, RMQ, and PPI questionnaires. Both groups saw a notable enhancement in their health-related QOL, as assessed by SF-12 scores. However, when considering therapeutic options, autologous PRP may provide a better choice due to its longer-lasting effectiveness.