A study investigating the effectiveness of combining pulsed radiofrequency (PRF) and platelet-rich plasma (PRP) treatments for alleviating chronic lumbosacral radicular pain caused by grade I spondylolisthesis is shedding light on new methods to manage this prevalent condition. Conducted at the University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam, this prospective study details the promising results from its initial evaluation of 96 patients over two years.
Chronic lumbosacral radicular pain is often debilitating, with many patients reporting higher levels of discomfort and work absence compared to those suffering from axial low back pain. To address this issue, researchers explored the potential of combining two minimally invasive procedures: PRF, known for its analgesic properties, and PRP, rich with growth factors to promote healing.
From March 2021 to March 2023, 96 patients with grade I spondylolisthesis (G1SL)—including both unstable and stable conditions—were treated with ultrasound-guided injections of PRF followed by PRP. The results of this innovative approach are promising. Pre-procedure assessments revealed significant differences between the two groups; the unstable group reported higher pain levels averaging 7.45 on the Visual Analog Scale (VAS), compared to 6.45 for the stable group.
Post-treatment, follow-up assessments every month revealed significant improvements for both groups. The VAS scores dropped markedly to 3.24 for stable patients and 3.53 for those with instability after one month. Importantly, no patients experienced severe complications or required open surgery during the six-month follow-up. This constitutes a significant finding for pain management strategies and indicates the safety of using this combined technique.
"A new treatment combining PRF and PRP applications appears beneficial in managing pain in regenerative medicine," noted the researchers. They emphasized the combined treatment's potential to provide relief without typical side effects associated with stronger pain medications or invasive procedures.
The researchers also observed substantial improvements using the Oswestry Disability Index (ODI), which assesses functional disability, indicating the treatment's effectiveness. Both groups exhibited improvements, with mean ODI scores showing marked enhancements post-procedure and stability over follow-up periods.
The study's findings align with previous research underscoring the benefits of both PRF and PRP treatments. PRF operates by modulating pain signals, affecting inflammatory pathways, and enabling recovery processes at the tissue level. Meanwhile, PRP injections introduce beneficial growth factors, which have been shown to assist healing processes and potentially reduce inflammation and pain.
The combined technique of PRF and PRP is particularly noteworthy because traditional transforaminal injections often expose patients to radiation during fluoroscopic guidance. Ultrasonographic techniques eliminate this drawback, making the procedures safer and providing real-time visualization for accurate needle placement. This advancement enhances patient safety and improves procedural success rates.
Although the absence of long-term data limits the conclusions of this study, results indicate the combined technique is both safe and effective for treating chronic radicular pain. Researchers stress the importance of conducting larger clinical trials to confirm and evaluate the long-term efficacy of this treatment method.
Researchers concluded, "Our study provides evidence of the effectiveness and safety of ultrasound-guided transforaminal PRF combined with PRP injection in managing G1SL with CLSR pain without severe nerve damage.” The results pave the way for new treatment modalities focused on improving patient outcomes through minimal invasiveness.
Further research is necessary to investigate long-term outcomes and mechanisms behind this effective treatment combination, particularly as patients seek alternatives to traditional, riskier surgical procedures.