الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 274 |  |  |
| | | from | 274 | | |
Abstract
Back pain is a growing problem worldwide, incurring enormous economic costs and disability. Current treatment modalities often provide adequate relief but fail to address underlying conditions. Recently the attention has increased towards the Facet joint disease which is a condition in which the joints of the spine become a source of low back pain. It is a very common disease process and its prevalence increases with aging.
Treatment of chronic LBP arising due to facet joint includes intraarticular injections, medial branch blocks, and radiofrequency neurotomy. Lumbar facet joint injections are useful in the diagnosis and therapeutic management of chronic LBP. The injections are performed by various techniques, however only the fluoroscopic-guided technique is considered reliable.
Steroid is one of the most commonly used injected drugs; however, previous studies have indicated that the long-term relief of low back pain after intra-articular steroid injection is only 18% to 63%. Intraarticular steroids injection also showed various side effects including; steroid induced hyperglycemia, gastrointestinal symptoms, vertigo/dizziness, glaucoma, and urticaria. Therefore, it seems meaningful to apply a new injectable drug and to prove its effectiveness and safety for the treatment of lumbar facet joint disease.
Autologous PRP consists of an increased concentration of autologous platelets suspended in a small amount of plasma, it was shown in various studies to be an appropriate injectable material with great potential in treating many different musculoskeletal disorders such as osteoarthritis, lateral epicondylitis, rotator cuff disease, achilles and patellar tendinopathy, hamstring injuries, and degenerative spine disease. The effects of PRP are attributed to stimulating various growth factors and cytokines that modulate the intraarticular environment, leading to reducing inflammation and stimulating anabolism in different tissues.
This study was conducted on total of 30 patients complaining of chronic low back pain which was shown to be originating from lumbar facet joint disease. The aim of our study was evaluating the ability of PRP as an effective intra-articular injectant compared to corticosteroids in improving facet joints MRI detected synovitis in correlation to clinical findings and LBP functional disability questionnaires results, comparing pre intervention results to post intervention follow up results at 3 month.
The participants were randomly assigned for intra-articular injection to either; group (I) (n =15) whom were injected with autologous platelet rich plasma and group (II) (n=15) were injected with corticosteroids (a mixture of 0.5% lidocaine and 5mg/ml of betamethasone) for comparative purpose. The injection was done under supervision of a consultant pain physician, fluoroscopy guided utilizing C-arm device for accurate intraarticular injection.
The participants of both groups were statistically highly comparable at base line regarding their demographic data (age and sex) and the disease duration. There was also non statistical significant difference between their clinical data as regards; maximum lumbar extension ROM measured by a goniometer and number of tender facet joints on palpation. Pain intensity was assessed using VAS and the scores were also comparable between the two groups.
The participants were subjected to functional disability questionnaires for low back pain (RMQ and ODI) and there was non statistical significant difference between them. Finally, all participants underwent MRI for their lumbar region where lumbar facet joints synovitis was detected and graded by a consultant radiologist and the findings were also statistically comparable.
Injection was done in all the joints that showed synovitis on MRI.
Follow up was done to all participants at 3 month post the intervention were all previous data was redone including; lumbar extension ROM, number of tender joints on palpation, VAS, RMQ, ODI and MRI for number of facet joints and their grades in the joints that showed signs of synovitis before the intervention.
The collected data was coded, tabulated, and statistically analyzed using SPSS program (Statistical Package for Social Sciences) software version 17.0.
The results of the participants of both groups showed highly significant improvement in all the parameters including; clinical (number of FJ showing tenderness on palpation and active lumber extension ROM), pain analysis (VAS), disability questionnaires (RMQ and ODI) and MRI detected synovitis (number of joints and their grade).
To our knowledge, our study is the first to correlate objectively the clinical and disability questionnaires to actual MRI detected synovitis at the same sites and showing the visible MRI demonstrated improvement in the number of joints showing synovitis and their grading.
Statistical comparative analysis between both groups showed that there was no statistical significant difference between the results of both groups, regarding all examined parameters at 3 month post the intervention. However, PRP injected joints showed statistical significant decrease in the grades of MRI detected synovitis -denoting improvement- in all lumbar FJ levels as compared to those injected with CS which showed statistical significant synovitis grade decrease at two levels only.
PRP is therefore -compared to the most commonly used CS- ; simple, low-cost together with their autologous nature, the lack of side-effect typical of CS as well as the possibility to delay the progression of facet joint arthropathy due to its regenerative nature through stimulating various growth factors, might be a stimulus to include PRP in our practice as an alternative option to more traditional intraarticular products, such as corticosteroids.