Epidural platelet-rich plasma versus corticosteroid for lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials

Epidural injections are commonly used for managing radiculopathy due to lumbar disc herniation. Platelet-rich plasma (PRP) has emerged as a biologic alternative to corticosteroids, but its comparative efficacy and safety remain uncertain. A systematic review and meta-analysis of randomized controlled trials was conducted following PRISMA guidelines (PROSPERO CRD420251067009). Comprehensive searches of MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science were performed through July 2025. Eligible studies enrolled adults with lumbar disc herniation receiving epidural PRP or corticosteroid injections, with pain and/or function reported using standardized scales. Pooled analyses used random-effects models with restricted maximum likelihood and Hartung–Knapp adjustment. Risk of bias was assessed using the Cochrane RoB2 tool, and certainty of evidence was evaluated with the GRADE framework. Six trials including 406 participants were identified. Pain outcomes did not differ significantly between groups at any follow-up point through six months (e.g., 3-month standardized mean difference − 0.63; 95% confidence interval − 1.58 to 0.33). At 3 months, functional disability showed little to no between-group difference (standardized mean difference 0.00; 95% confidence interval − 0.26 to 0.26; I² = 0%). Adverse-event reporting was sparse and inconsistent. No serious neurological complications or infections were reported, but comparative safety could not be established. Heterogeneity in intervention protocols and limited sample sizes reduced precision. Overall certainty of evidence ranged from very low to moderate. Current randomized evidence does not demonstrate a consistent difference between epidural platelet-rich plasma and corticosteroid injections in pain or functional outcomes through six months. Given the substantial heterogeneity, imprecision, and limited safety reporting, the evidence remains insufficient to support routine substitution of corticosteroids with platelet-rich plasma. Larger, standardized trials are needed to clarify long-term effectiveness and safety. PROSPERO CRD420251067009.