Ultrasound guided intralesional injections of platelet rich plasma in the treatment of iliac crest pain syndrome and the associated low back pain
- 1Department of Propedeutics of Internal Diseases and Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
- 2Clinic of Rheumatology, Universitetska mnogoprofilna bolnica za aktivno lecenie Kaspela EOOD, Plovdiv, Bulgaria
Abstract
IntroductionIliac Crest Pain Syndrome (ICPS) was established as a discrete and common cause for Low Back Pain (LBP) of soft tissue origin. Previous studies on ICPS proposed enthesopathy of Erector Spinae (ES) muscle and Thoracolumbar fascia (TLF) at the Posterior Super Iliac Spine (PSIS), as well as pathology of the Long Posterior Sacroiliac Ligament (LPSL) as main pathologic substrates in ICPS. Platelet rich plasma (PRP) is an orthobiologic treatment that was found to be especially efficacious in soft tissue pathology, like enthesopathy and ligamentopathy. In this study we aimed to assess the efficacy of PRP intralesional injections at the ES/TLF/LPSL entheses in patients with ICPS and associated LBP.MaterialThe study was partially funded by a postdoctoral research grant of the Medical University of Plovdiv and included 46 ICPS patients. Each patient received two intralesional PRP injections in their ES/TLF/LPSL entheses at the PSIS within a three-week interval. All procedures were performed under direct US guidance. The primary endpoint was pain reduction on VAS (0–100) in six months. Secondary endpoints included assessment of the range of motions in the lumbar spine, disability (RMDS: 1–24) and health status (HAQ: 0–3), as well as patients’ satisfaction (five points Likert scale), all in six months.ResultsPain in rest decreased from 53 to 16 mm, pain on motion—from 69,5 to 18 mm on VAS in six months. Lumbar range of motion increased with the average of 2,5 cm both in the sagittal and coronal planes. Regarding PROs, RMDS dropped from 15 to 6,5 points, and HAQ from 1.13 to 0.62 in six months.DiscussionIn the present study, PRP was applied directly intralesional under US guidance, following a strict and easily reproducible protocol. The results showed a significant positive effect on all the investigated parameters: pain, spinal mobility and PROs. Thus, PRP US guided injections at the PSIS could represent a valid and efficacious treatment option in patients with ICPS and the associated LBP.
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BibTeX
@article{todorov2026ultrasound,
title = {{Ultrasound guided intralesional injections of platelet rich plasma in the treatment of iliac crest pain syndrome and the associated low back pain}},
author = {Plamen Todorov Todorov and Lily Mekenyan and Lily Mekenyan and Leonidas Seventekidis and Anastas Batalov and Anastas Batalov},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1943518},
url = {https://doi.org/10.3389/fmed.2026.1943518},
note = {CC BY},
}
RIS
TY - JOUR
TI - Ultrasound guided intralesional injections of platelet rich plasma in the treatment of iliac crest pain syndrome and the associated low back pain
AU - Plamen Todorov Todorov
AU - Lily Mekenyan
AU - Lily Mekenyan
AU - Leonidas Seventekidis
AU - Anastas Batalov
AU - Anastas Batalov
PY - 2026
DA - 2026/10/23
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1943518
UR - https://doi.org/10.3389/fmed.2026.1943518
AB - IntroductionIliac Crest Pain Syndrome (ICPS) was established as a discrete and common cause for Low Back Pain (LBP) of soft tissue origin. Previous studies on ICPS proposed enthesopathy of Erector Spinae (ES) muscle and Thoracolumbar fascia (TLF) at the Posterior Super Iliac Spine (PSIS), as well as pathology of the Long Posterior Sacroiliac Ligament (LPSL) as main pathologic substrates in ICPS. Platelet rich plasma (PRP) is an orthobiologic treatment that was found to be especially efficacious in soft tissue pathology, like enthesopathy and ligamentopathy. In this study we aimed to assess the efficacy of PRP intralesional injections at the ES/TLF/LPSL entheses in patients with ICPS and associated LBP.MaterialThe study was partially funded by a postdoctoral research grant of the Medical University of Plovdiv and included 46 ICPS patients. Each patient received two intralesional PRP injections in their ES/TLF/LPSL entheses at the PSIS within a three-week interval. All procedures were performed under direct US guidance. The primary endpoint was pain reduction on VAS (0–100) in six months. Secondary endpoints included assessment of the range of motions in the lumbar spine, disability (RMDS: 1–24) and health status (HAQ: 0–3), as well as patients’ satisfaction (five points Likert scale), all in six months.ResultsPain in rest decreased from 53 to 16 mm, pain on motion—from 69,5 to 18 mm on VAS in six months. Lumbar range of motion increased with the average of 2,5 cm both in the sagittal and coronal planes. Regarding PROs, RMDS dropped from 15 to 6,5 points, and HAQ from 1.13 to 0.62 in six months.DiscussionIn the present study, PRP was applied directly intralesional under US guidance, following a strict and easily reproducible protocol. The results showed a significant positive effect on all the investigated parameters: pain, spinal mobility and PROs. Thus, PRP US guided injections at the PSIS could represent a valid and efficacious treatment option in patients with ICPS and the associated LBP.
SN - 2296-858X
ER -