Platelet-Rich Plasma Facet Joint Injections for Post-Traumatic Lumbar Facet-Mediated Pain: A Two-Patient Case Report
Preethash Sundar, Ivan Urits, Omar Viswanath, Christopher L Robinson, Alan D Kaye, Jamal HasoonBackground
Lumbar facet-mediated pain is a common contributor to axial low back pain and may occur after traumatic or mechanical injury, even when advanced imaging demonstrates only mild degenerative or nonspecific findings. Standard interventional treatment pathways often include diagnostic medial branch blocks followed by radiofrequency ablation, or intra-articular facet joint injections with corticosteroids. However, some patients wish to avoid corticosteroid exposure or neuroablative procedures. Platelet-rich plasma (PRP) is a biologic injectate that could be used for the treatment of facet-mediated low back pain, although the available clinical evidence remains very limited
Case Presentation
We present two patients with post-traumatic axial low back pain clinically localized to the lumbar facet joints who elected to undergo lumbar facet joint PRP injections after declining medial branch blocks, radiofrequency ablation, and corticosteroid injections to the facet joints. The first patient was a woman in her 40s who developed low back pain after a motor vehicle collision. Lumbar MRI demonstrated minimal structural abnormalities, but examination revealed focal facet-region pain worsened with lumbar extension. She underwent PRP injections at the bilateral L3–4 and L4–5 facet joints, corresponding to the areas of maximal pain. At 6-week follow-up, she reported approximately 60% pain relief and continued participation in physical therapy and a home exercise program. The second patient was a man in his 50s who developed low back pain after falling from a ladder. Imaging demonstrated mild lumbar spondylosis and degenerative disc disease. He preferred PRP over corticosteroid injections, medial branch blocks, or radiofrequency ablation. PRP injections were performed at the L4–5 and L5–S1 facet joints, corresponding to his areas of maximal pain. At 6-week follow-up, he reported approximately 70% sustained pain relief. No complications were noted in either case.
Conclusion
These cases suggest that lumbar facet joint PRP injections may provide moderate pain improvement in carefully selected patients with clinically suspected facet-mediated pain after acute injury, particularly those wishing to avoid corticosteroid injections or ablative procedures. However, diagnostic certainty may be lower when confirmatory medial branch blocks are not performed. Further controlled studies are needed to define optimal patient selection, PRP preparation, injection technique, and durability of response.