Platelet-Rich Plasma versus Corticosteroid Injections for Facet and Sacroiliac Joint Pain: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

Abstract

INTRODUCTION: Facet and sacroiliac joint (SIJ) pathology are common causes of chronic low back pain. Corticosteroid (CS) injections provide short-term relief but limited durability. Platelet-rich plasma (PRP), an autologous biologic, may offer longer-lasting benefit. We performed a systematic review and meta-analysis of randomized and quasi-randomized controlled trials comparing PRP with corticosteroids. MATERIAL AND METHODS: PubMed, Cochrane Library, Scopus, Embase, Web of Science, CINAHL Complete, Virtual Health Library, and ScienceDirect were searched up to 21 June 2025. Eligible studies were randomized or quasi-randomized controlled trials comparing intra- or peri-articular PRP with corticosteroids for facet or sacroiliac joint pain. Primary outcome was the mean pain scores changes from baseline to first, third, and sixth months using a scale of 10 scores (0= no pain, and 10= worst pain). Secondary outcome was disability using Oswestry Disability Index (ODI) or Modified ODI (MODQ). Data was pooled using mean difference (MD) for pain scores outcome, and standardized mean difference (SMD) for disability outcome. Random-effects meta-analysis was performed using 'Meta' package in R (RStudio version 4.4.3), with subgroup analyses by joint (facet vs SIJ) to facilitate further interpretation. RESULTS: Ten randomized and quasi-randomized controlled trials (six facet, and four SIJ) enrolling 392 patients (mean age 47.04 years, 50.6% male) were included. At one month, pain outcomes favored PRP but did not reach statistical significance (MD -0.35, 95% CI -1.30 to 0.60; p = 0.4696; I2 = 90.6%). At three months, PRP significantly reduced pain versus corticosteroids (MD -1.32, 95% CI -2.14 to -0.50; p = 0.0015), with consistent benefit across facet and SIJ subgroups. Superiority persisted at six months (MD -1.70, 95% CI -3.10 to -0.30; P = 0.0171). Disability outcome showed no significant difference at one month (SMD 0.05, 95% CI -0.45 to 0.54), and at three months (SMD -0.63, 95% CI -1.29 to 0.03; P = 0.0613). CONCLUSION: PRP appears to be a promising intervention; however, current evidence remains inconclusive. Available data suggest that PRP may provide superior medium- and long-term pain reduction compared with corticosteroid injections for facet and SIJ, supporting its potential role as a biologic therapy in spinal pain management. Nevertheless, the certainty of this evidence is limited, and further well-designed, adequately powered studies with standardized PRP protocols are required to confirm these findings.