Epidural platelet-rich plasma long-term outcome is better than steroid for prolapsed lumbar intervertebral discs: A meta-analysis of randomized controlled trials

Why This Matters

Epidural steroid injections are commonly used for radicular pain from lumbar disc herniation, but their benefits are often short-lived. Platelet-rich plasma (PRP) has emerged as a potential alternative, raising an important clinical question: should treatment prioritize rapid symptom relief or longer-term improvement?

What the Research Found

This meta-analysis of 3 randomized controlled trials (n=132) compared epidural PRP injections with epidural steroid injections in patients with lumbar disc-related pain. The results demonstrated a clear time-dependent difference between the two treatments.

Key Findings:

  • At 1 month: steroid injections provided greater pain relief than PRP
  • At 6 months: PRP demonstrated greater pain reduction (MD −1.51) and improved function (ODI −9.71)
  • Steroid group showed worsening pain between 1 and 6 months
  • PRP showed gradual, sustained improvement over time
  • Overall pattern: steroids = faster relief, PRP = longer-lasting benefit

Clinical Takeaways

    • Recognize that epidural steroids may provide faster short-term relief, but benefits may decline over time
    • Be aware that PRP demonstrated greater pain and functional improvement at 6 months
    • Consider aligning treatment selection with patient goals (rapid relief vs sustained improvement)
    • Discuss expected timelines clearly, as treatment response differs significantly between options
    • Interpret results cautiously given small sample size (3 trials, 132 patients) and variability across studies

Where Collaborative Spine Care May Support This

Manual medicine and conservative spine care approaches may help bridge the gap between short-term symptom relief and longer-term functional recovery, supporting patients regardless of injection strategy and potentially reducing reliance on repeated interventions.

Reference

Ermawan R, Corrigan H, Fachreza MS, et al. Epidural platelet-rich plasma long-term outcome is better than steroid for prolapsed lumbar intervertebral discs: A meta-analysis of randomized controlled trials. Spine Surg Relat Res. 2026;10(1):36–42.
DOI: http://dx.doi.org/10.22603/ssrr.2025-0007
PubMed: https://pubmed.ncbi.nlm.nih.gov/41695894/