PRP CESI

[bedrock]

I had another patient specifically request PRP for a CESI. I have done PRP lumbar epidurals before, but only for rare specific reasons.

Personally I think a steroid makes more sense as he has cervical rad from foraminal stenosis.

This the 3 or 4th patient that has requested a PRP CESI and so I’m wondering if any of you have done those and what has been your experience?

Again I’m not really looking to start doing these, but I’m also looking for info on safety and efficacy of CESI with PRP.

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[SSdoc33]

I had another patient specifically request PRP for a CESI. I have done PRP lumbar epidurals before, but only for rare specific reasons.

Personally I think a steroid makes more sense as he has cervical rad from foraminal stenosis.

This the 3 or 4th patient that has requested a PRP CESI and so I’m wondering if any of you have done those and what has been your experience?

Again I’m not really looking to start doing these, but I’m also looking for info on safety and efficacy of CESI with PRP.

not sure you are gonna find any.

im not aware of any

 

[lobelsteve]

I had another patient specifically request PRP for a CESI. I have done PRP lumbar epidurals before, but only for rare specific reasons.

Personally I think a steroid makes more sense as he has cervical rad from foraminal stenosis.

This the 3 or 4th patient that has requested a PRP CESI and so I’m wondering if any of you have done those and what has been your experience?

Again I’m not really looking to start doing these, but I’m also looking for info on safety and efficacy of CESI with PRP.

Why is it different with human experimentation between neck and back?

 

[drusso]

not sure you are gonna find any.

im not aware of any

I just did one this morning.

Platelet lysate is better than PRP for the spine:

Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes - PubMed

In people with chronic WAD and facet-mediated pain, preliminary data suggests that PRP is safe and it is feasible to move forwards with randomized studies to further investigate efficacy and effectiveness.

pubmed.ncbi.nlm.nih.gov

Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach - PubMed

Background The increasing burden of musculoskeletal disorders combined with the high utilization of opiates and the relatively limited ability of traditional approaches to satisfactorily address many of these conditions has spurred an increased interest in alternative treatments such as...

pubmed.ncbi.nlm.nih.gov

Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach - PubMed

Background The increasing burden of musculoskeletal disorders combined with the high utilization of opiates and the relatively limited ability of traditional approaches to satisfactorily address many of these conditions has spurred an increased interest in alternative treatments such as...

pubmed.ncbi.nlm.nih.gov

Exp Biol Med (Maywood). 2025 Feb 4:250:10390.
doi: 10.3389/ebm.2025.10390. eCollection 2025.

Is platelet-rich plasma better than steroids as epidural drug of choice in lumbar disc disease with radiculopathy? Meta-analysis of randomized controlled trials​

• PMID: 39968415
• PMCID: PMC11832311
• DOI: 10.3389/ebm.2025.10390

Abstract​

The current meta-analysis was performed to analyze the efficacy and safety of platelet-rich plasma (PRP) as an epidural injectate, in comparison with steroids in the management of radiculopathy due to lumbar disc disease (LDD). We conducted independent and duplicate searches of the electronic databases (PubMed, Embase and Cochrane Library) in March 2024 to identify randomized controlled trials (RCTs) analyzing the efficacy of epidural PRP for pain relief in the management of LDD. Animal or in vitro studies, clinical studies without a comparator group, and retrospective or non-randomised clinical studies were excluded. Diverse post-intervention pain scores [visual analog score (VAS)] and functional scores [Oswestry Disability Index (ODI), SF-36], as reported in the reviewed studies, were evaluated. Statistical analysis was performed using STATA 17 software. 5 RCTs including 310 patients (PRP/Steroids = 153/157) were included in the analysis. The included studies compared the efficacy and safety of epidural PRP and steroids at various time-points including 1, 3, 6, 12, 24, and 48 weeks. Epidural PRP injection was found to offer comparable pain relief (VAS; WMD = -0.09, 95% CI [-0.66, 0.47], p = 0.641; I2 = 96.72%, p < 0.001), functional improvement (ODI; WMD = 0.72, 95% CI [-6.81, 8.25], p = 0.524; I2 = 98.73%, p < 0.001), and overall health improvement (SF-36; WMD = 1.01, 95% CI [-1.14, 3.17], p = 0.224; I2 = 0.0%, p = 0.36) as epidural steroid injection (ESI) at all the observed time points in the included studies without any increase in adverse events or complications. Epidural administration of PRP offers comparable benefit as epidural steroid injection (ESI) in the management of radiculopathy due to LDD. The safety profile of the epidural PRP is also similar to ESI.
Keywords: PRP; biologics; degenerative disc disease; epidural steroid; pain relief.

 

[Ducttape]

wasnt he asking about PRP in the epidural space?

the second one was a "study" that started with 1664 patients ending with 14, of which 6 got "epidurals" (others got "overfill from facet injections".


of note, out of these 14 out of 1665 people, only 4 of them had pain scores >5. the other 10 had pain scores ranging from 3 to 5.

 

[drusso]

wasnt he asking about PRP in the epidural space?

the second one was a "study" that started with 1664 patients ending with 14, of which 6 got "epidurals" (others got "overfill from facet injections".


of note, out of these 14 out of 1665 people, only 4 of them had pain scores >5. the other 10 had pain scores ranging from 3 to 5.

I recommend platelet lysate in the epidural space.

 

[Ducttape]

okay, im not sure that the articles showed that much regarding PL either.

is there a meta-analysis regarding PL for cervical epidural space? you seem to have all that access to such regenerative data, and as i am not defending its use, I'll let you post appropriate studies.

 

[lobelsteve]

okay, im not sure that the articles showed that much regarding PL either.

is there a meta-analysis regarding PL for cervical epidural space? you seem to have all that access to such regenerative data, and as i am not defending its use, I'll let you post appropriate studies.

Outcome measure is getting paid, not patient outcomes.

 

[au bon pain]

I just did one this morning.

Platelet lysate is better than PRP for the spine:

Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes - PubMed

In people with chronic WAD and facet-mediated pain, preliminary data suggests that PRP is safe and it is feasible to move forwards with randomized studies to further investigate efficacy and effectiveness.

pubmed.ncbi.nlm.nih.gov

Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach - PubMed

Background The increasing burden of musculoskeletal disorders combined with the high utilization of opiates and the relatively limited ability of traditional approaches to satisfactorily address many of these conditions has spurred an increased interest in alternative treatments such as...

pubmed.ncbi.nlm.nih.gov

Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach - PubMed

Background The increasing burden of musculoskeletal disorders combined with the high utilization of opiates and the relatively limited ability of traditional approaches to satisfactorily address many of these conditions has spurred an increased interest in alternative treatments such as...

pubmed.ncbi.nlm.nih.gov

Exp Biol Med (Maywood). 2025 Feb 4:250:10390.
doi: 10.3389/ebm.2025.10390. eCollection 2025.

Is platelet-rich plasma better than steroids as epidural drug of choice in lumbar disc disease with radiculopathy? Meta-analysis of randomized controlled trials​

• PMID: 39968415
• PMCID: PMC11832311
• DOI: 10.3389/ebm.2025.10390

Abstract​

The current meta-analysis was performed to analyze the efficacy and safety of platelet-rich plasma (PRP) as an epidural injectate, in comparison with steroids in the management of radiculopathy due to lumbar disc disease (LDD). We conducted independent and duplicate searches of the electronic databases (PubMed, Embase and Cochrane Library) in March 2024 to identify randomized controlled trials (RCTs) analyzing the efficacy of epidural PRP for pain relief in the management of LDD. Animal or in vitro studies, clinical studies without a comparator group, and retrospective or non-randomised clinical studies were excluded. Diverse post-intervention pain scores [visual analog score (VAS)] and functional scores [Oswestry Disability Index (ODI), SF-36], as reported in the reviewed studies, were evaluated. Statistical analysis was performed using STATA 17 software. 5 RCTs including 310 patients (PRP/Steroids = 153/157) were included in the analysis. The included studies compared the efficacy and safety of epidural PRP and steroids at various time-points including 1, 3, 6, 12, 24, and 48 weeks. Epidural PRP injection was found to offer comparable pain relief (VAS; WMD = -0.09, 95% CI [-0.66, 0.47], p = 0.641; I2 = 96.72%, p < 0.001), functional improvement (ODI; WMD = 0.72, 95% CI [-6.81, 8.25], p = 0.524; I2 = 98.73%, p < 0.001), and overall health improvement (SF-36; WMD = 1.01, 95% CI [-1.14, 3.17], p = 0.224; I2 = 0.0%, p = 0.36) as epidural steroid injection (ESI) at all the observed time points in the included studies without any increase in adverse events or complications. Epidural administration of PRP offers comparable benefit as epidural steroid injection (ESI) in the management of radiculopathy due to LDD. The safety profile of the epidural PRP is also similar to ESI.
Keywords: PRP; biologics; degenerative disc disease; epidural steroid; pain relief.

Whenever I see terms like “disc disease” it makes me wish I could go back in time and change a few bits of radiology parlance. It would probably give me back the equivalent of a few months of my life spent over the years explaining this nonsense to patients.

 

[lobelsteve]

Whenever I see terms like “disc disease” it makes me wish I could go back in time and change a few bits of radiology parlance. It would probably give me back the equivalent of a few months of my life spent over the years explaining this nonsense to patients.

"age appropriate findings"

 

[au bon pain]

"age appropriate findings"

Amen.

Or being a mammal that walks upright.

Or living on a planet with gravity.

 

[rexed]

I recommend platelet lysate in the epidural space.

Could you elaborate a little more, Is platelet lysate better tolerated than PRP in regards to injection discomfort or is there a better safety profile or better observed efficacy? Thanks!