The efficacy and safety of endoscopic surgery combined with platelet-rich plasma for lumbar disc herniation: a systematic review and meta-analysis

Guimei Guo^1*Yu Cheng²Xinyue Yu¹Wensi Ouyang³Changwei Zhao¹

• ¹The Third Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
• ²Zigong Chinese Medicine Hospital, Zigong, China
• ³Hunan University of Chinese Medicine, Changsha, China

Objective: Lumbar disc herniation (LDH) is a common spinal disorder with an increasing annual incidence, significantly impairing patients' quality of life. Platelet-rich plasma (PRP) has become a viable biologically based treatment alternative in clinical practice in recent years. Methods: A comprehensive investigation was carried out across eight databases, from their inception until October 2025, to pinpoint pertinent articles assessing the efficacy of PRP therapy in the context of LDH. Two independent reviewers carefully reviewed and approved studies by applying predetermined inclusion and exclusion criteria. Furthermore, they assessed the eligible literature's methodological quality. VAS scores for back and leg pain, JOA scores, ODI scores, disc height, treatment-related complication, and recurrence were among the outcome measures examined. Results: This comprehensive analysis included twelve studies with 960 patients diagnosed with LDH. The aggregated analysis unveiled the subsequent observations: back VAS scores and leg VAS scores exhibited a significant reduction at the time intervals (back VAS scores: 3 months, MD = -0.58, 95% CI: -0.84 to -0.31, P < 0.0001; 6 months, MD = -0.32, 95% CI: -0.48 to -0.16, P = 0.0001; ≥12 months, MD = -0.40, 95% CI: -0.51 to -0.28, P < 0.00001; last follow-up, MD = -0.23, 95% CI: -0.36 to -0.10, P = 0.0005; very low certainty) (leg VAS scores: 3 months, MD = -0.38, 95% CI: -0.52 to -0.24, P < 0.00001; 6 months, MD = -0.53, 95% CI: -0.67 to -0.38, P < 0.00001; ≥12 months, MD = -0.38, 95% CI: -0.62 to -0.14, P = 0.002; last follow-up, MD = -0.35, 95% CI: -0.60 to -0.10, P = 0.007; very low certainty). The JOA scores increased dramatically at the time intervals (3 months, MD = 1.91, 95% CI: 0.65 to 3.18, P = 0.003; 6 months, MD = 0.97, 95% CI: 0.44 to 1.50, P = 0.0003; ≥12 months, MD = 1.60, 95% CI: 0.37 to 2.84, P = 0.01; last follow-up, MD = 1.26, 95% CI: 0.31 to 2.21, P = 0.009; very low certainty). The ODI scores showed significant improvements at the time intervals.