Comparison of CT-guided platelet-rich plasma versus steroid/anesthetic injection for treatment of sacroiliac joint pain: a randomized, single-blinded, controlled trial

AJNR Am J Neuroradiol. 2026 Mar 24:ajnr.A9307. doi: 10.3174/ajnr.A9307. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Low back pain (LBP) is a leading cause of disability and health care costs in the U.S., with the sacroiliac joint (SIJ) implicated in up to 30% of cases. Treatments such as steroid/anesthetic injection (SAI) and opioids offer short-term relief but are associated with systemic side effects and potential for dependency. Platelet-rich plasma (PRP), a biologically active autologous treatment, has demonstrated regenerative and anti-inflammatory properties that may offer a safer and more durable alternative, with some promise seen in the spine on prior trials. This study aimed to compare clinical effectiveness of CT-guided PRP versus SAI for SIJ-mediated low back pain using robust inclusion criteria.

MATERIALS AND METHODS: This single-blinded, randomized controlled trial enrolled 44 adult patients with chronic SIJ pain confirmed by ≥50% pain relief following anesthetic block. Participants were then randomized to receive either PRP or SAI by CT-guidance, with outcomes assessed over 3 months. Primary outcome was change in numeric rating scale (NRS) pain scores. Secondary outcomes included modified Oswestry disability questionnaire, SF-12 quality-of-life metrics, functional mobility, and opioid use.

RESULTS: Forty participants (20 per arm) remained for analysis at 3 months with both groups showing significant pain reduction (PRP vs. SAI; -3.0 ± 3.2 vs. -1.8 ± 2.4 mean change ± SD, p=.24). SAI produced greater early relief, while PRP demonstrated more sustained improvement, including a non-significant trend toward higher responder rates (≥50% NRS reduction; 60% vs. 35%, p=.11) and greater gains in disability and physical quality of life at 3 months outcome assessment.

CONCLUSIONS: PRP and SAI both improved SIJ-related LBP, with PRP demonstrating a slower onset but potentially more durable benefit. PRP appears to be a viable, safe alternative to corticosteroids in managing chronic SIJ pain. Larger trials with longer follow-up are warranted to validate these findings and inform clinical guidelines.

PMID:41876223 | DOI:10.3174/ajnr.A9307