Disclosures: Andrew J. Duarte, MD: Nothing to disclose

Case Description: To report the use of a leukocyte-rich platelet-rich plasma injection in a patient with a T11-L1 interspinous ligament (ISL) sprain who had previously failed conservative management and corticosteroid injections.

Setting: Outpatient sports medicine clinic.

Patient: An otherwise healthy 25-year-old female.

Assessment/Results: The patient presented to the clinic with a chief complaint of chronic upper lumbar and mid-thoracic back pain. Physical exam revealed full range of motion with pain at endpoint of lumbar flexion and tenderness to palpation. After a full examination, the patient was provided an initial ultrasound guided T11-L1 ISL injection with triamcinolone and referred for a course of physical therapy. Her pain had not resolved thus a second injection was performed with betamethasone. Several weeks post-procedurally, her pain persisted. Ultrasound examination revealed hypervascularity and edema in the soft tissue consistent with the diagnosis of an ISL sprain. This was subsequently confirmed with MRI. Afterwards, an injection of 3 mL of leukocyte-rich platelet rich plasma (LR-PRP; Arthrex Angel) was performed.

Discussion: The diagnosis of ISL sprains can be an elusive, particularly in a patient who presents with a chief complaint of back pain without prior trauma. Management of an ISL sprain typically involves activity modification. While it is impossible to prove, the repeat injection with a more potent corticosteroid may have contributed to the patient’s ISL sprain. Thus, the use LR-PRP was employed given the theoretical benefit of promoting ligamentous healing with the various growth factors isolated in the injectate. Upon follow up with patient 3 months later, the patient noted improvement in pain and will be receiving an additional LR-PRP injection and further physical therapy.

Conclusion: For ISL sprains, the use of LR-PRP may be helpful in promoting tendon repair. This case report demonstrates an index case and further study of this application for PRP is warranted.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-leukocyte-rich-platelet-rich-plasma-injection-for-interspinous-ligament-sprain-after-corticosteroid-injections-a-case-report/