Evaluation of changes in spinal posture following fluoroscopy-guided transforaminal epidural platelet-rich plasma injection in chronic low back pain using the DIERS formetric 4D spine posture analysis system: A prospective observational study

Background: Chronic low back pain (LBP) is a leading cause of disability and impaired quality of life. Platelet-rich plasma (PRP) has emerged as a regenerative intervention for lumbar discogenic pain, but its effect on spinal postural parameters remains unclear. Aims and Objectives: This study aimed to evaluate changes in spinal posture following fluoroscopy-guided transforaminal epidural PRP injection using the DIERS formetric 4D spine posture analysis system. Materials and Methods: An observational study was conducted over 1 year on 43 patients with chronic LBP who underwent fluoroscopy-guided transforaminal epidural PRP injection followed by standardized rehabilitation. Outcomes were assessed at baseline and 8 weeks. Three-dimensional spinal posture was analyzed using the DIERS formetric 4D surface topography system. Results: Most spinal and pelvic postural parameters remained unchanged at 8 weeks, including pelvic obliquity, pelvic torsion, sagittal imbalance, sagittal arrows, kyphotic angle, and lordotic angle. Coronal imbalance improved significantly, with VP–DMV1 decreasing from 12 (5–14) to 8 (5–9) and VP–DMV2 from 10 (6–14) to 8 (5–9) (P<0.0001). Straight leg raise test angle improved from 50° (42.5–60°) to 70° (60–80°) (P=0.0004). Visual Analog Scale decreased from 7 (7–8) to 4 (3–4.5), modified Oswestry Disability Index decreased from 62 (57–72) to 32 (30–34), and Short Form-12 scores improved significantly in both physical and mental components (all P<0.0001). Conclusion: Despite marked symptomatic and functional recovery, most spinal postural and pelvic parameters did not change at 8 weeks, suggesting that PRP benefits may occur independentlyof short-term postural correction.