Platelet-Rich Plasma Injections for Adults with Cervical and Lumbar Facet Joint Mediated Pain: A Retrospective Analysis
Vishal P. Varshney1, Geoff Schneider2, Arun Gupta3
Neck and low back pain are considered some of the most common chronic musculoskeletal pain conditions. Cervical and lumbar facet joints have been identified as a common source of spine-related pain, with an estimated prevalence of 60% and 40% respectively. Commonly, intra-articular lidocaine and corticosteroid injections are used to confirm diagnosis and relieve facet joint mediated pain. However, research demonstrates limited long-term efficacy, and that pain recurrence can still occur despite these therapies.
As a result, there is growing interest in using platelet-rich plasma (PRP) injections as a treatment for those with persistent spinal pain. By promoting wound healing, tissue repair, and axon regeneration, PRP is thought to reverse the underlying pathophysiology of certain pain conditions, possibly eliminating the need for recurrent repeat injections and treatments. PRP has yet to be studied in cervical and lumbar facet joint mediated pain.
In this retrospective analysis, 30 patients (ages 18-55) were contacted by telephone to determine their self-reported outcomes pertaining to spine-related pain intensity (within one month and their current status) and satisfaction (Modified MacNab questionnaire) post-PRP injections.
PRP injections were performed in a standardized process as follows: after informed consent, the PRP injection involved obtaining 30 cc of autologous blood, resulting in 4-6 cc of PRP. 1cc of PRP solution was injected into each joint with confirmed intra-articular position using standard fluoroscopic approach (Figure 1). Patients participated in a rehabilitation program for 8 weeks post-injection.
Overall, 21 patients (ages 35-64 years) treated with PRP injections for persistent facet joint pain (cervical = 7, lumbar = 14) were reviewed. The median pain intensity (on a Numeric Pain Rating Scale (NPRS)) and duration of pain prior to the injections was 7/10 (range 4-9) and 60 months (range 12-360), respectively. There was a statistically significant reduction in self-reported spine-related pain intensity at one month and in the current period post-PRP injections (p<0.001), as per paired t-test analysis (Figure 2). There was a clinically relevant reduction (>2 points on a NPRS) in self-reported spine-related pain intensity reported for the current time period (up to 52 months post-injection) in 16 patients. 16 patients reported at least fair to excellent satisfaction with the PRP intervention (Figure 3).
This retrospective study provided data suggesting that PRP injections for cervical and lumbar facet joint mediated pain may be effective in reducing pain intensity and preserving patient satisfaction for a period of time independent of repeat procedures required. This is in keeping with what is known about PRP with regards to its ability to promote tissue repair and axon regeneration. A prospective study incorporating a larger sample is necessary to validate these findings.