Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN
Lumbar radiculopathy pain is typically treated by neurosurgery or guided lumbar epidural steroids. Research suggests that Platelet-rich plasma (PRP) and lumbar steroid injections provide similar long-term pain relief and functional improvement for patients suffering from lumbar radiculopathy. While steroids provided faster relief in the short term, PRP offered a safer, longer-lasting alternative without the side effects associated with repeated steroid use.
- In our practice we typically do not offer PRP as a stand alone treatment. We will use it in combination with Prolotherapy injections. This article will focus on the question of comparing PRP and cortisone for lumbar radiculopathy.
PRP treatment takes your blood, spins it into concentrated blood platelets, and reinjects it back into the problem areas of the spine. Your blood platelets contain growth and healing factors. When concentrated through simple centrifuging, your blood plasma becomes “rich” in healing factors, thus the name Platelet RICH plasma.
Video summary
Pain radiating down the leg, often resulting from a pinched nerve in the back, can be one of the most disabling symptoms experienced. Many people may not realize that even herniated discs are frequently linked to ligamentous lumbar instability.
Slouching is a common behavior, especially in our current age where cell phones and computers are prevalent in daily life. Unfortunately, this posture stretches out the ligaments in both the neck and the back. As a result, individuals may experience chronic muscle spasms, clicking, and cracking noises, in addition to pain traveling down the leg.
The most effective treatment involves maintaining good posture. It is important to look up at your computer screen and avoid looking down at your cell phone. In cases where ligamentous lumbar instability is present, prolotherapy is indicated as an appropriate intervention.
Multiple studies have demonstrated that PRP injections are superior to conventional epidural steroid injections
A May 2022 study comparing PRP versus steroids for treating lumbar disc herniation and lumbar radiculopathy comes to us from the Asian Journal of Surgery (1).
- Twenty-five patients participated in this study.
- They received an injection of PRP under fluoroscopic guidance via transforaminal epidural injection into the area of the affected nerve root. Their outcomes were assessed with pain and disability questionnaires and the Straight Leg Raising Test (SLRT).
Study Results: “Patients who received transforaminal injections with autologous PRP showed statistically significant improvements on all three evaluation tools. The improvements were sustained over a twelve-month follow-up and there were no associated complications. Transforaminal injection with autologous PRP helps patients relieve chronic pains and be able to return to work. Besides, autologous PRP can be considered as a good alternative to epidural steroids in the management of lumbar disc herniation.”
A December 2025 paper in the journal Frontiers in neurology (2) writes that “multiple studies have demonstrated that PRP injections are superior to conventional epidural steroid injections in alleviating radicular leg pain and improving functional outcomes. . . with a lower incidence of adverse events, thereby highlighting its favorable safety and tolerability profile. As an autologous product, PRP also avoids the potential complications of steroids, including immunosuppression, osteoporosis, and neurotoxicity, making it particularly suitable for patients who respond poorly to traditional therapies or have contraindications.”
A March 2025 study in the Journal of orthopaedic surgery and research (3) reviewed previous studies at assess pain levels and how much the pain affected daily activities in patients with lumbar radicular pain after treatments with epidural corticosteroid injections and platelet rich plasma PRP. The review included seven studies (four randomized controlled trials and three prospective studies), covering 416 patients. Results showed corticosteroid injections helped patients move and function better early on compared to PRP. However, over time, there were no clear differences in pain or daily function between the two treatments.
A May 2023 study in the Indian journal of orthopaedics (4) compared transforaminal steroid injections and platelet-rich plasma (PRP) injections in people with discogenic lumbar radiculopathy.
Sixty patients took part in this study. They were randomly assigned to get either a single PRP injection (29 patients) or a single steroid injection (31 patients). Doctors measured their pain and function using the Visual Analogue Scale (VAS), the modified Oswestry Low Back Pain Disability Index (MODI), and the straight leg raise test (SLRT). Measurements were taken before treatment and again at 1, 3, and 6 months after the injection. Both groups were similar before the treatment began.
Results
Both groups improved after treatment, with better lower pain and disability scores. In the PRP group, significant improvement in pain and function lasted through all follow-ups (1, 3, and 6 months). In the steroid group, this level of improvement was only seen at 1 and 3 months. Steroid injections worked better at 1 month, but PRP gave better results at 6 months. At 3 months, there was no clear difference between the two treatments. After 6 months, more than 90% of the PRP group had a negative straight leg raise test (vast improvement), compared to 62% in the steroid group.
While both PRP and steroid injections helped patients improve in the short term (up to 3 months), the PRP injections continued to give meaningful benefits for 6 months.
Notes on PRP as an epidural
Recently PRP has been studied as an epidural. A February 2025 study in the journal Experimental biology and medicine (5) assessed the effectiveness and safety of platelet-rich plasma (PRP) as an epidural injectate in comparison to steroids for treating radiculopathy caused by lumbar disc disease.
This study compared PRP to steroid injections in alleviating pain and enhancing functionality in affected individuals. A total of five previously published studies involving 310 patients (153 treated with PRP and 157 with steroids) were incorporated into the meta-analysis. These studies evaluated the efficacy and safety of epidural PRP and steroid injections at various time intervals: 1, 3, 6, 12, 24, and 48 weeks following the treatment.
The findings indicated that epidural PRP injection provided pain relief, functional enhancement, and overall health improvement comparable to that of epidural steroid injection (ESI) at all assessed time points in the studies included, without any increase in adverse events or complications. The epidural administration of PRP demonstrates benefits similar to those of epidural steroid injection in managing radiculopathy associated with lumbar disc disease. Furthermore, the safety profile of epidural PRP is akin to that of epidural steroid injection.
More reading
Spontaneous intracranial hypotension – lumbar epidurals and cervical spine instability
Alternatives to Epidural Steroid Injections for lumbar back pain
References
1 Le VT, Dao LT, Nguyen AM. Transforaminal injection with autologous platelet-rich plasma in lumbar disc herniation: A single-center prospective study in Vietnam. Asian Journal of Surgery. 2022 May 28. [Google Scholar]
2 Tong Y, Yu L, Luo K, Yan X, Chen M, Wang L. Recent advances and evolving strategies in the treatment of lumbar disc herniation. Frontiers in Neurology. 2025 Dec 19;16:1706784. [Google Scholar]
3 Wang X, Zhang Y. Therapeutic interventions of platelet-rich plasma versus corticosteroid injections for lumbar radicular pain: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025 Mar 25;20(1):306. [Google Scholar]
4 Saraf A, Hussain A, Sandhu AS, Bishnoi S, Arora V. Transforaminal injections of platelet-rich plasma compared with steroid in lumbar radiculopathy: a prospective, double-blind randomized study. Indian Journal of Orthopaedics. 2023 Jul;57(7):1126-33. [Google Scholar]
5 Muthu S, Viswanathan VK, Gangadaran P. Is platelet-rich plasma better than steroids as epidural drug of choice in lumbar disc disease with radiculopathy? Meta-analysis of randomized controlled trials. Experimental Biology and Medicine. 2025 Feb 4;250:10390. [Google Scholar]