Preparation methods and clinical outcomes of platelet-rich plasma for chronic discogenic low back pain: A systematic review and meta-analysis of randomized controlled trials.
TL;DR
Although no significant differences were found in pain and functional improvement between PRP and control groups for pain or function, these findings should be interpreted with caution given the very low certainty of evidence.
Abstract
Objective
To evaluate platelet-rich plasma (PRP) preparation methods and composition and compare its effectiveness versus other comparative therapies in treating chronic discogenic low back pain (LBP). TYPE OF STUDY Systematic review and meta-analysis. LITERATURE SURVEY We searched for randomized controlled trials (RCTs) that compared PRP to either placebo, corticosteroids, or other active comparators for treating chronic discogenic LBP. The search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, from their inception through April 2025. METHODOLOGY Two independent reviewers extracted information from the included RCTs, consisting of study characteristics, patient demographics, intervention details, PRP preparation and composition details, and patient reported outcome measures (PROMs). A series of meta-analyses were conducted, using the random-effects model for outcomes reported in at least three studies. Pain and spine-specific function PROMs were pooled and analyzed using the standardized mean difference. A p value <.05 was considered statistically significant. SYNTHESIS Eleven studies (623 patients) were included in this systematic review and meta-analysis. Information on PRP preparation and composition was limited and heterogeneous. Complete information about the methodology to prepare PRP that would allow replication was reported in only one (9%) study. Complete platelet yield and leukocyte counts were reported in two (18%) studies. No significant differences were found in pain and functional improvement between PRP and control groups at any time point, although there was a trend favoring PRP at 3 and 6 months. High heterogeneity was observed across all outcomes. Two serious adverse events were reported only following PRP treatment.
Conclusions
PRP preparation methods and composition are inadequately reported in RCTs for chronic discogenic LBP. Although no significant differences were found between PRP and control groups for pain or function, these findings should be interpreted with caution given the very low certainty of evidence. Improved reporting standards for PRP preparation and composition, along with larger high-quality RCTs, are needed to enable meaningful comparison of outcomes.