Intra-Articular Platelet Rich Plasma vs Corticosteroid Injections for Sacroiliac Joint Pain: A Double-Blinded, Randomized Clinical Trial.

OBJECTIVE: Using stringent inclusion criteria, a double-blinded study protocol, and fluoroscopically guided injections, we compare intra-articular sacroiliac joint platelet-rich plasma injections with intra-articular steroids. DESIGN: Double-blind, randomized controlled trial. SETTING: Two large university-based interdisciplinary spine centers. SUBJECTS: A total of 26 patients with a positive diagnostic block (>80% relief). METHODS: Subjects who had a positive diagnostic block were randomized to undergo either a fluoroscopically guided intra-articular injection of steroid or a platelet-rich plasma injection. Follow-up was at 1 month, 3 months, and 6 months. Outcomes included level of pain, as indicated on a 0- to 100-mm numeric pain rating scale, and functional disability score, obtained via the Oswestry Disability Index (ODI). RESULTS: At 1, 3, and 6 months, both groups improved; however, subjects who received steroid injections reported lower pain scores than did subjects who received platelet-rich plasma. Using categorical data, we observed significantly more responders (defined as pain scores that improved by 50% or more from baseline) at 1 and 3 months in the group who received steroids than in the group who received platelet-rich plasma. CONCLUSION: Although both groups showed improvements in pain and function, the steroid group had significantly greater response and significantly more responders than did the platelet-rich plasma group.

Medial branch nerve block and ablation as a novel approach to pain related to vertebral compression fracture.

PURPOSE OF REVIEW: This review offers a critical examination of the biomechanical model that posits the posterior elements as a substantial contributor to pain in vertebral fracture. Further, the review assesses the treatment of posterior-element-associated pain in the setting of vertebral compression fracture in relation to vertebral augmentation. RECENT FINDINGS: In 2015, the only prospective randomized trial comparing percutaneous vertebroplasty with facet blockade was published in which authors found that percutaneous vertebroplasty produced better pain relief and function based on Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analog scale in the short term (≤1 week). However, differences in pain relief at 1 month and 12 months were not statistically significant. SUMMARY: The posterior elements may play a significant role in the pain generated after vertebral compression fractures. Treatment of the posterior element pain through medial branch radiofrequency ablation or facet injections may be another tool in providing analgesia in those with pain after vertebral compression fractures.