Comparison of CT-Guided Platelet-Rich Plasma versus Steroid/Anesthetic Injection for Treatment of Sacroiliac Joint...

Low back pain (LBP) is a leading cause of disability and health care costs in the United States, with the sacroiliac joint (SIJ) implicated in up to 30% of cases. Treatments such as steroid/anesthetic injection (SAI) and opioids offer short-term relief but are associated with systemic side effects and potential for dependency. Platelet-rich plasma (PRP), a biologically active autologous treatment, has demonstrated regenerative and anti-inflammatory properties that may offer a safer and more durable alternative, with some promise seen in the spine on prior trials. This study aimed to compare clinical effectiveness of CT-guided PRP versus SAI for SIJ-mediated LBP using robust inclusion criteria.

This single-blinded, randomized controlled trial enrolled 44 adult patients with chronic SIJ pain confirmed by ≥50% pain relief after anesthetic block. Participants were then randomized to receive either PRP or SAI by CT guidance, with outcomes assessed over 3 months. Primary outcome was change in numeric rating scale (NRS) pain scores. Secondary outcomes included modified Oswestry Disability Questionnaire, Short Form-12 quality-of-life metrics, functional mobility, and opioid use.

Forty participants (20 per arm) remained for analysis at 3 months with both groups showing significant pain reduction (PRP versus SAI[mean change ± SD]: -3.0 ± 3.2 versus -1.8 ± 2.4; P = .24). SAI produced greater early relief, whereas PRP demonstrated more sustained improvement, including a nonsignificant trend toward higher responder rates (≥50% NRS reduction; 60% versus 35%; P = .11) and greater gains in disability and physical quality of life at 3 months outcome assessment.

PRP and SAI both improved SIJ-related LBP, with PRP demonstrating a slower onset but potentially more durable benefit. PRP appears to be a viable, safe alternative to corticosteroids in managing chronic SIJ pain. Larger trials with longer follow-up are warranted to validate these findings and inform clinical guidelines.