■椎间盘起源的下背痛是常见的,但具有挑战性的治疗。盘内富血小板血浆(PRP)一直被提倡,但与椎间盘炎的风险有关。硬膜外PRP侵入性较小,可以避免这种风险。很少有研究评估硬膜外PRP治疗无神经根病的椎间盘源性腰痛的有效性和安全性,并且研究的随访时间很短。
■前瞻性评估12个月PRP硬膜外注射对无神经根病的下背痛患者的有效性,怀疑是光盘来源。
■11例连续患有难治性腰痛的患者怀疑是椎间盘起源(相容性临床评估;阴性的腰骶内侧支传导阻滞(MBB)和/或具有高强度区(HIZ)的磁共振成像(MRI),修改1或2次更改)参与。每个人都接受一次(n=5)或两次(n=6)硬膜外注射(尾部或层间)。PRP为白细胞/红细胞耗尽,平均血小板浓度为约2X全血。数值评定量表(NRS),疼痛残疾生活质量问卷(PDQQ)评分,Oswestry残疾指数(ODI)评分,对镇痛摄入量的影响,在治疗前和治疗后3,6和12个月记录治疗满意度和认可.
■治疗后记录了疼痛和残疾的显着改善。Pre-,3、6和12个月后平均(SD)NRS评分为7.8(1.8),5.8(2.7),5.1(2.5),分别为4.9(2.8)(F=7.2;p=0.002)。PRP硬膜外术后12个月,NRS的平均改善为36%,36%的患者经历了≥50%的疼痛缓解(95%置信区间(CI):2%,70%),73%实现了最小的临床重要差异(MCID)(95%CI:41%,100%)。记录了类似程度的残疾改善(PDQQ和ODI)。在一年后,50%的镇痛药使用者减少了摄入量,91%的人对治疗感到满意,并会向家人和朋友推荐该程序。无并发症报告。
■该试点项目表明,PRP硬膜外注射可在疼痛和残疾方面提供适度但显着的改善,对于怀疑是椎间盘起源的腰痛患者,持续至少12个月。鼓励进行其他研究,包括更大的样本量和强大的研究设计。
UNASSIGNED: Low back pain of disc origin is common yet challenging to treat. Intradiscal platelet rich plasma (PRP) has been advocated, but is associated with risk of discitis.
Epidural PRP is less invasive and avoids this risk. Few studies exist evaluating effectiveness and safety of
epidural PRP for discogenic low back pain without radiculopathy and the follow-up of the studies tends to be short.
UNASSIGNED: Prospectively evaluate for 12 months the effectiveness of PRP
epidural injections for patients with low back pain without radiculopathy, suspected to be of disc origin.
UNASSIGNED: 11 consecutive patients with refractory low back pain suspected to be of disc origin (compatible clinical assessment; negative lumbosacral medial branch blocks (MBBs) and/or magnetic resonance imaging (MRI) with high intensity zone (HIZ), Modic 1 or 2 changes) participated. Each underwent one (n = 5) or two (n = 6)
epidural injections (caudal or interlaminar). The PRP was leukocyte/red cell depleted with an average platelet concentration of ∼2X whole blood. Numerical rating scale (NRS), Pain Disability Quality-Of-Life Questionnaire (PDQQ) score, Oswestry Disability Index (ODI) score, effect on analgesic intake, treatment satisfaction and endorsement were recorded prior to and at 3, 6 and 12-months post-treatment.
UNASSIGNED: Significant improvements in pain and disability were documented post-treatment. Pre-, 3, 6, and 12-month post mean(sd) NRS scores were 7.8(1.8), 5.8(2.7), 5.1(2.5), 4.9(2.8) respectively (F = 7.2; p = 0.002). At 12 months post PRP
epidural, the mean improvement in NRS was 36%, 36% had experienced ≥50% pain relief (95% confidence interval (CI): 2%, 70%), and 73% achieved minimal clinically important differences (MCID) (95% CI: 41%, 100%). Similar magnitude improvements in disability (PDQQ and ODI) were documented. At 1-year post, 50% of analgesic users had reduced intake, 91% were satisfied with the treatment and would recommend the procedure to family and friends. No complications were reported.
UNASSIGNED: This pilot project suggests that PRP epidural injections provide modest yet significant improvements in pain and disability that lasts at least 12 months in patients with low back pain suspected to be of disc origin. Additional research including larger sample size and robust study design is encouraged.