Rehabilitation

Journal Reading
Date: 2021 / 12 / 22 (Wed.)

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Introduction
- Sacroiliac Joint (SIJ) Pain:
- pain at SIJ area
- elicited by provocation tests; relief after local anesthesia
- presentation variable (point prevalence 25%)
- Platelet-rich plasma (PRP):
- safe & promising Tx for MSK injury
- growth factors, proteins… → promotes joint repair & regeneration

Limited high-quality research on effectiveness of PRP on SIJ pain…

→ PRP similar to/better than steroid to improve pain & function? 3
Methods:
- a Double-blind, Randomized controlled trial (RCT)
- at 2 university-based spine centers
- IRB approval obtained
- Screening Inclusion criteria:
- chronic unilateral low back pain (VAS ≥ 5). w/o radiculopathy
- ≥ 3 provocation maneuvers (+):
distraction test, thigh thrust, Gaenslen’s test, compression test, sacral thrust
- lack of improvement after ≥ 4 wks of PT
- no prior SIJ injections

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Methods
- Exclusion criteria:
- age < 18 or > 80
- midline pain above L5 level
- signs of nerve root impingement
- coagulopathy / systemic infection / pregnancy
- proceeding Diagnostic IA block under live fluoroscopy
- contrast medium injected to confirm IA placement
- joint then infiltrated w/ 2% Lidocaine (2mL)
- after 30min, p’t who reported pain relief > 80% were included
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Methods
- Randomization:
- p’t randomized to IA corticosteroid or PRP groups
- procedures double-blinded
only 1 nurse & research coordinator not blinded (not involved in f/u evaluation)
- all p’t had peripheral blood drawn
corticosteroid & PRP prepared by nurse, syringe then covered

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Methods
- IA injections performed w/ contrast medium placement confirmation
- corticosteroid: 1mL Betamethasone sodium phosphate & acetate suspension
(6mg/mL) + 1mL 2% Lidocaine (single injection)
- PRP: 2mL PRP (single injection)
- 60mL blood drawn, centrifuged 15min, using EmCyte PurePRP II kits

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Methods
- Primary outcomes (evaluated at 1M, 3M, 6M):
- Pain VAS in 0 - 10 scale
- Responders defined as VAS improvement ≥ 50% from baseline
- Functional disability Oswestry Low Back Pain Disability Questionnaire (ODI)

- Complications (before & after the procedure) recorded

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Results

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Results

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Results
- Pain
- Steroid group reported significantly lower VAS than PRP (1M, 3M, 6M)
- MD no improvements of > 30% from baseline in PRP group
- Steroid group reported significantly more responders than PRP (1M, 3M)

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Results
- Function
- Steroid group reported significantly lower ODI than PRP (1M, 3M)

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Discussion
- only few prior studies on PRP efficacy for SIJ pain
- a RCT in 2017 compared RPR vs. steroid SIJ injections
favored RPR in pain improvement (6wk, 3M)
- not blinded
- used sono-guide → might also inject PRP into posterior ligamentus complex
- did not perform diagnostic block

- < 50% of p’t initially screened had (+) diagnostic block

- Association between exam maneuvers & diagnostic block poor

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Discussion
- w/ stringent criteria, limited improvement in pain & function of PRP noted
- steroid group showed greater benefit in VAS & ODI (1M, 3M)
- no complications in either group observed

- Limitations:
- small sample size (stringent criteria / cost of PRP kits)
- several p’t lost f/u (particularly at 6M)
- did not f/u beyond 6M
- predominance of female & white p’t
- variability in type & constitution of PRP used worldwide 16
Conclusion
- In patients with true SIJ pain, improvements in pain and function were noted in
both PRP and steroid injection groups.

- Significantly greater response in pain (1, 3, 6 months) and function (1, 3 months)
were noted in the steroid group.

- This study does not replicate findings described in prior studies, and continued
research of regenerative medicine therapies are needed.

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Thank
you !!

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