ROSM uses research-based methods to lead patients back to full function and health. Our team is dedicated to providing effective, minimally-invasive options to maintain and enhance our patients’ quality of life. Please review these studies for more information on our treatment modalities. If you have any further questions, do not hesitate to contact us.
Jiuping Wu, MSc; Jingjing Zhou, MSc; Chibing Liu, MSc; Jun Zhang, MSc; Wei Xiong, MSc; Yang Lv, MSc; Rui Liu, MSc; Ruiqiang Wang, MSc; Zhenwu Du, MD, PhD; Guizhen Zhang, MD, PhD; Qinyi Liu, MD, PhD
Abstract
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Objectives:
To compare the effectiveness and safety between autologous platelet-rich plasma (PRP) and Local Anesthetic (LA)/corticosteroid in intra-articular injection for the treatment of lumbar facet joint syndrome.
Methods:
Forty-six eligible patients with lumbar facet joint syndrome were randomized into group A (intra-articular injection with PRP) and group B (intra-articular injection with LA/corticosteroid). The following contents were evaluated: pain visual analog scale (VAS) at rest and during flexion, and the Roland-Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI), and modified MacNab criteria for pain relief and applications of post-treatment drugs. All outcome assessments were performed immediately after and at 1 week, 1, 2, 3, and 6 months after treatment.
Results:
No significant difference between groups was observed at baseline. Compared with pretreatment, both group A and group B demonstrated statistical improvements in the pain VAS score at rest or during flexion, the RMQ, and the ODI (P < 0.01). And there were significant differences between the 2 groups on the above-mentioned items (P < 0.05). For group B, subjective satisfaction based on the modified MacNab criteria and objective success rate were highest (80% and 85%) after 1 month, but only 50% and 20% after 6 months. However, for group A, they increased over time. In addition, there were no treatment-related complications in either group during follow-up.
Conclusions:
Both autologous PRP and LA/corticosteroid for intra-articular injection are effective, easy, and safe enough in the treatment of lumbar facet joint syndrome. However, autologous PRP is a superior treatment option for longer duration efficacy.
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Fernando Kirchner and Eduardo Anitua
Abstract
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Context:
Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge.
Aims:
The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain.
Settings and Design:
The study was designed as an observational retrospective pilot study. Eighty-six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012.
Subjects and Methods:
One intradiscal, one intra-articular facet, and one transforaminal epidural injection of PRGF-Endoret under fluoroscopic guidance-control were carried out in 86 patients with chronic LBP in the operating theater setting.
Statistical Analysis Used:
Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow-up time points on pain reduction after treatment.
Results:
Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF-Endoret injections showed a statistically significant drop from 8.4 ± 1.1 before the treatment to 4 ± 2.6, 1.7 ± 2.3, and 0.8 ± 1.7 at 1, 3, and 6 months after the treatment, respectively, with respect to all the time evaluations (P < 0.0001) except for the pain reduction between the 3 and 6 month whose signification was lower (P < 0.05). The analysis of the VAS over time showed that at the end point of the study (6 months), 91% of patients showed an excellent score, 8.1% showed a moderate improvement, and 1.2% were in the inefficient score.
Conclusions:
Fluoroscopy-guided infiltrations of intervertebral discs and facet joints with PRGF in patients with chronic LBP resulted in significant pain reduction assessed by VAS.
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Jiuping Wu, MSc, Zhenwu Du, MD, PhD, Yang Lv, MSc, Jun Zhang, MSc, Wei Xiong, MSc,
Ruiqiang Wang, MSc, Rui Liu, MSc, Guizhen Zhang, MD, PhD, and Qinyi Liu, MD, PhD
Abstract
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Background and Objectives:
Lumbar facet joint syndrome is currently suggested to be a main source of axial low back pain, and a large portion of axial low back pain is caused by disorders in lumbar facet joints. Intra-articular injection is one of the most common treatment methods in the early clinical application. Therefore, we attempt to seek a new injectable material, autologous platelet rich plasma (PRP), to treat lumbar facet syndrome, as well as to assess its therapeutic effectiveness and safety.
Study Design:
A prospective clinic evaluation.
Setting:
The outpatient clinic of a single academic medical center.
Methods:
Total 19 patients with lumbar facet joint syndrome (8 men, 11 women; mean ages: 52.53 ± 6.79 years, range: 38 – 62 years) were enrolled to receive lumbar facet joint injection with autologous PRP under x-ray fluoroscopic control. Patients were followed up immediately, at one week, one month, 2 months, and 3 months following treatment, and the elements of this analysis included low back pain visual analogue scale (VAS) at rest and during flexion, Roland-Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI), and modified MacNab criteria for the pain relief.
Results:
All the 19 patients completed the intra-articular injections with autologous PRP successfully. At one week after treatment, low back pain reduced significantly compared with prior to treatment both at rest and during flexion. The outcomes were assessed as “good” or “excellent” for 9 patients (47.37%) immediately after treatment, 14 patients (73.68%) at one week, 15 patients (78.95%) at one month, 15 patients (78.95%) at 2 months, and 15 patients (78.95%) at 3 months. Statistically significant differences were observed based on RMQ and a more than 10% improvement in lumbar functional capacity was observed based on ODI between pre-treatment and post-treatment. In addition, there were no severe relevant complications during the whole process of injection and follow-up period.
Limitations:
A control group and the curative effect observations with longer follow-up may lead to a more convincing result for our study.
Conclusions:
In the short-term period of 3 months, the new technique of lumbar facet joint injection with autologous PRP is effective and safe for patients with lumbar facet joint syndrome.
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Annu Navani, MD; Deepak Gupta, BA, MS-II
Abstract
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The goal of this case review is to evaluate safety and efficacy with the use of intra-articular platelet-rich plasma (PRP) in patients with sacroiliac (SI) joint (SIJ) pain. The secondary outcomes include additional medical treatments, hospitalization, and surgery. SIJ pain contributes significantly to the social and economic burden due to its long-standing and debilitating course. Current treatments include either interventional procedures with transient benefits or invasive surgical options. PRP has been used clinically in various settings for its anti-inflammatory and tissue repair properties attributed to growth factors. Ten patients with chronic SIJ pain who tried and failed conservative treatments were administered a single injection of 4 mm autologous PRP into the joint under fluoroscopic guidance after careful clinical and imaging evaluation. The patients were followed up at 1, 3, 6, and 12 months post injection and primary and secondary outcomes were recorded. Verbal analog scale score for pain of all patients decreased more than 50% and their function increased for the period of 12 months. None of the patients presented to the hospital or clinic or received any treatments or surgery after the PRP injection. There were no adverse reactions, side effects, or complications. PRP presents as a promising option based on our preliminary observation. Larger, well-designed randomized controlled trials are warranted to understand the full breath of the efficacy, risks, and complications from the use of PRP for SIJ pain.
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Gordon D. Ko; Sean Mindra; Gordon E. Lawson; Scott Whitmore; and Leigh Arseneau
Abstract
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BACKGROUND:
Two-thirds of adults worldwide will experience low back pain at some point in their life. In the following case series, we present four patients with sacroiliac (SI) joint instability and severe chronic low back pain, which was refractory to other treatment modalities.
OBJECTIVE:
We investigated the efficacy of platelet-rich plasma (PRP) injections, a novel orthobiologic therapy, for reducing SI joint pain, improving quality of life, and maintaining a clinical effect.
METHODS:
Short-form McGill Pain Questionnaire (SFM), Numeric Rating Scale (NRS), and Oswestry Low Back Pain and Disability Index were used for evaluation of treatment at pretreatment, 12 months and 48-months after treatment.
RESULTS:
At follow-up 12-months post-treatment, pooled data from all patients reported a marked improvement in joint stability, a statistically significant reduction in pain, and improvement in quality of life. The clinical benefits of PRP were still significant at 4-years post-treatment.
CONCLUSIONS:
Platelet-rich plasma therapy exhibits clinical usefulness in both pain reduction and for functional improvement in patients with chronic SI joint pain. The improvement in joint stability and low back pain was maintained at 1- and 4-years post-treatment.
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Varun Singla, MD; Yatindra K. Batra, MD; Neerja Bharti, DNB; Vijay G. Goni, MS; Neelam Marwaha, MD
Abstract
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Background:
Despite widespread use of steroids to treat sacroiliac joint (SIJ) pain, their duration of pain reduction is short. Platelet-rich plasma (PRP) can potentially enhance tissue healing and may have a longer-lasting effect on pain.
Objectives:
To assess the efficacy and safety of PRP compared with methylprednisolone in ultrasound-guided SIJ injection for low back pain.
Study Design:
Prospective randomized open blinded end point (PROBE) study.
Methods:
Forty patients with chronic low back pain diagnosed with SIJ pathology were randomly allocated into 2 groups. Group S received 1.5 mL of methylprednisolone (40 mg/mL) and 1.5 mL of 2% lidocaine with 0.5 mL of saline, while Group P received 3 mL of leukocyte-free PRP with 0.5 mL of calcium chloride into ultrasound-guided SIJ injection. Visual analog scale (VAS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, Short Form (SF-12)
Health Survey scores, and complications (if any) were evaluated at 2 weeks, 4 weeks, 6 weeks, and 3 months.
Results:
Intensity of pain was significantly lower in Group P at 6 weeks (median [interquartile range (IQR)] = 1 [1 to 1] vs. 3.5 [2 to 5]; P = 0.0004) and 3 months (Median [IQR] = 1 [1 to 3] vs. 5 [3 to 5]; P = 0.0002) as compared to Group S. The efficacy of steroid injection was reduced to only 25% at 3 months in Group S, while it was 90% in Group P. A strong association was observed in patients receiving PRP and showing a reduction of VAS ≥ 50% from baseline when other factors were controlled. The MODQ and SF-12 scores were improved initially for up to 4 weeks but deteriorated further at 3 months in Group S, while both the scores improved gradually for up to 3 months in Group P.
Conclusion:
The intra-articular PRP injection is an effective treatment modality in low back pain involving SIJ.
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