Ultrasound-guided injection of steroids versus platelet-rich plasma for sacroiliac joint chronic pain management

Abstract

Background The spectrum of pain and disability from sacroiliac joint dysfunction is extremely variable. The treatment of SIJ pain remains a therapeutic challenge. Intra-articular SIJ infiltrations with local anesthetic and corticosteroids have the most reliable evidence supporting their use. New modalities have been introduced, such as platelet-rich plasma (PRP) injection. Aim This study aimed to assess and compare the efficacy of ultrasound (US) guided intra-articular and peri-articular SIJ injection with steroids (methylprednisolone) versus platelet-rich plasma (PRP) in relieving chronic SIJ pain and to assess the patient’s satisfaction, record any complications and deal with them accordingly. Patients and methods Fifty patients undergoing sacroiliac joint injection for the treatment of SIJ pain were included in the study. All patients have been randomly allocated to one of two groups: Group S received US-guided intra-articular and peri-articular injection of bupivacaine and methylprednisolone. Group P received US-guided intra-articular and peri-articular SIJ injection of bupivacaine and PRP. Results Demographic data showed no statistically significant difference between both groups. The provocative tests, the VAS score, and the MODQ score at preinjection showed no statistically significant difference. At 2 and 4 weeks postinjection, there was a statistically significant difference between the two groups showing higher values in group S than in group P. At six weeks postinjection, provocative tests were recorded in both groups with no significant difference between them. On the other hand, at eight weeks and four months postinjection, there was a statistically significant difference between the two groups showing higher values for group P than group S. The SAPS score was compared between the two groups and showed no statistically significant difference between them in any of the follow-up periods. As for the efficacy between the two groups, no statistically significant difference was noted. Regarding the complications between the two groups, there was no statistically significant difference. Conclusion US-guided PRP and steroid (methylprednisolone) injections into the SIJ are safe and effective modalities for reducing functional disability as well as decreasing low back pain.