"Platelet-Rich Plasma" Epidural Injection an Emerging Strategy in Lumbar Disc Herniation
Condition: PRP
MeSH terms: Intervertebral Disc Displacement
Study type: Interventional

Summary: 
      To evaluate the efficacy of platelet-rich plasma (PRP; double-spin) in treatment of
      single-level lumbar herniated nucleus pulposus (HNP) in comparison to triamcinolone. RCT was
      conducted with 30 patients included.
    

Detailed description: 
      The study was a randomized controlled trial, triple-blind, single-center/surgeon/assessor.
      The study was conducted between April 2019 to May 2021. We evaluated 30 patients (both
      genders) aged 20-55 years, having failed conservative treatment of unilateral HNP undergone
      for at least 6 weeks, with visual analogue scale (VAS) of greater than 30, and confirmed a
      single-level HNP, corelated to clinical, by MRI. The exclusion criteria included previous
      spine surgery or epidural injection, progressive neurological deficit, cauda equina,
      coagulopathy-related conditions, associated cervical myelopathy, systemic bone and joint
      diseases. All patients had to have been exempted from NSAIDs for at least one week. Patients
      were treated by transforaminal epidural injections. Fifteen patients were in triamcinolone
      and PRP groups each. PRP was obtained from 24 ml venous blood through standardized
      double-spin protocol. Participants were fifteen patients each in triamcinolone and PRP
      groups. The same postoperative protocols and medications were applied. The visual analogue
      scale of leg (LegVAS), collected at baseline, 2, 6, 12, and 24 weeks, was the primary
      outcome. The BackVAS, Oswestry Disability Index (ODI), adverse event, and treatment failure
      were the secondary endpoints. All subjects were analyzed according to the intention-to-treat
      principle. All statistical analyses were performed with STATA 17.
    

Intervention name(s): platelet rich plasma; Triamcinolone
Intervention type(s): Drug; Drug
Intervention description(s): 1. 26 ml of blood was obtained from each patient (6ml each in 4 CPDA and 2ml in EDTA for CBC) 2. First-spin of 900g for 5 minutes (Kokusan, H-19alpha, 25°C) 3. Three layers formed: transfer top layer (platelet poor plasma) and middle layer (platelets and WBC) to another sterile tube (about 3.3 ml), discard bottom layer (RBC) 4. Second-spin of 1000g for 10 minutes 5. The upper one third was discarded (platelet poor plasma) by pipet, the remaining was mixed by turning 10 times 6. Total 4 ml of PRP; 40 mg triamcinolone with 1% lidocaine, total of 2 ml
Other intervention name(s): PRP; kenacort
Intervention MeSH terms: Triamcinolone
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Thirty patients were treated by transforaminal epidural injections. Fifteen patients were in triamcinolone and PRP groups each. PRP was obtained from 24 ml venous blood through standardized double-spin protocol. Participants were fifteen patients each in triamcinolone and PRP groups. The same postoperative protocols and medications were applied. The visual analogue scale of leg (LegVAS), collected at baseline, 2, 6, 12, and 24 weeks, was the primary outcome.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: PRP, HNP, lumbar HNP