Comparison of CT-Guided Platelet-Rich Plasma vs Steroid/Anesthetic Injection for Treatment of Sacroiliac Joint Pain: A Randomized, Single-Blinded, Controlled Trial
- 1From the Department of Radiology and Imaging Sciences (M.E.P., G.S., T.A.H., L.M.S.), University of Utah Health Sciences Center, Salt Lake City, Utah
- 2Department of Physical Medicine and Rehabilitation (Z.L.M.), University of Utah Health Sciences Center, Salt Lake City, Utah
- 3Department of Radiology (R.C.C.), Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
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.
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BibTeX
@article{peckham2026comparison,
title = {{Comparison of CT-Guided Platelet-Rich Plasma vs Steroid/Anesthetic Injection for Treatment of Sacroiliac Joint Pain: A Randomized, Single-Blinded, Controlled Trial}},
author = {Miriam E. Peckham and Zachary L. McCormick and Ghazaleh Safazadeh and Troy A. Hutchins and Ruth C. Carlos and Lubdha M. Shah},
journal = {AJNR: American Journal of Neuroradiology},
year = {2026},
month = nov,
doi = {10.3174/ajnr.a9307},
url = {https://doi.org/10.3174/ajnr.a9307},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparison of CT-Guided Platelet-Rich Plasma vs Steroid/Anesthetic Injection for Treatment of Sacroiliac Joint Pain: A Randomized, Single-Blinded, Controlled Trial
AU - Miriam E. Peckham
AU - Zachary L. McCormick
AU - Ghazaleh Safazadeh
AU - Troy A. Hutchins
AU - Ruth C. Carlos
AU - Lubdha M. Shah
PY - 2026
DA - 2026/11/06
JO - AJNR: American Journal of Neuroradiology
DO - 10.3174/ajnr.a9307
UR - https://doi.org/10.3174/ajnr.a9307
AB - 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.
SN - 0195-6108
SN - 1936-959X
ER -