CLINICAL OUTCOMES OF PLATELET-RICH PLASMA IN SACROILIAC JOINT DYSFUNCTION: A CASE SERIES

BackgroundSacroiliac joint (SIJ) dysfunction is a recognized source of low back pain.Recent reviews show longer-lasting relief with Platelet-Rich Plasma (PRP) than corticosteroids, but evidence is limited by protocol and patient variability. Case reportWe describe four cases of SIJ dysfunction treated with leukocyte-rich PRP without external activation, with platelet concentrations ranging from 4.41 to 5.67 times that of peripheral blood.Three patients (female, 46; female, 20; male, 75) underwent unilateral, bilateral, and unilateral SIJ injections, respectively, using a standardized protocol: 2.5 mL of intra-articular PRP confirmed by fluoroscopic contrast, and 4 mL PRP at the posterior sacroiliac ligaments under ultrasound guidance.In case 1, pain decreased from 6/10 to 2/10 after 2 months, with only mild discomfort when seated on hard surfaces.In case 2, right-sided pain dropped from 7/10 to 3/10 with sustained improvement for 4 months; the left side responded poorly.In case 3, pain reduced from 6/10 to 4/10 for 3 months, with limited overall benefit-possibly due to a multifactorial pain etiology in a older patient with other spinal degenerative changes.In case 4 (female, 19), only peri-ligamentous PRP was administered under ultrasound, as intra-articular contrast placement under fluoroscopic guidance was not achievable.Pain decreased from 7/10 to 3/10 after 1 month, with sustained functional improvement. ConclusionDiscussion: These cases highlight the variable clinical response to PRP in SIJ dysfunction, reflecting literature findings.While randomized controlled trials (RCTs) typically use single injections, case series often apply 2-3 sessions in refractory cases.Outcomes appear influenced by anatomical, technical, and individual factors, including comorbidities.Conclusion: PRP appears to be a safe and potentially effective therapy for longterm relief.Large RCTs with 12-month follow-up are needed to establish consensus on platelet concentration, leukocyte content, activation methods, injection volumes and frequency.Detailed protocol standardization is essential to ensure reproducible and comparable outcomes.