Supplementary file 1_The efficacy and safety of endoscopic surgery combined with platelet-rich plasma for lumbar disk herniation: a systematic review and meta-analysis.pdf

ObjectiveLumbar disk herniation (LDH) is a common spinal disorder with an increasing annual incidence, significantly impairing patients’ quality of life. In recent years, platelet-rich plasma (PRP) has emerged as a viable biologically based treatment alternative in clinical practice. The present study aimed to conduct a thorough review and meta-analysis to systematically assess the safety and effectiveness of endoscopic surgery combined with PRP for the treatment of LDH.
MethodsA comprehensive search was conducted across eight databases from their inception until October 2025 to identify relevant articles assessing the efficacy of PRP therapy for LDH. Two independent reviewers carefully reviewed and selected studies using predefined inclusion and exclusion criteria. Furthermore, they assessed the eligible literature’s methodological quality. Visual analog scale (VAS) scores for back and leg pain, Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, disk height, treatment-related complications, and recurrence were among the outcome measures examined. Stata version 17.0 and Review Manager version 5.4.1 were used for statistical analysis. In addition, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence for each outcome.
ResultsThis comprehensive analysis included 12 studies comprising 960 patients diagnosed with LDH. The aggregated results demonstrated significant reductions in both back and leg VAS scores across all evaluated time points. For back pain, VAS scores decreased significantly at 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) and at last follow-up (MD = −0.23, 95% CI: −0.36 to −0.10, p = 0.0005; very low certainty). Similarly, leg VAS scores were significantly reduced at 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); and at last follow-up (MD = −0.35, 95% CI: −0.60 to −0.10, p = 0.007; very low certainty). JOA scores increased significantly at all time points: 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), and at last follow-up (MD = 1.26, 95% CI: 0.31 to 2.21, p = 0.009; very low certainty). ODI scores also showed significant improvements at 3 months (MD = −2.64, 95% CI: −4.19 to −1.08, p = 0.0009); 6 months (MD = −2.05, 95% CI: −2.95 to −1.14, p < 0.00001); ≥12 months (MD = −2.72, 95% CI: −5.22 to −0.22, p = 0.03); and at last follow-up (MD = −1.53, 95% CI: −2.45 to −0.61, p = 0.001; very low certainty). There was a significant difference in disk height (MD = 0.74, 95% Cl: 0.52 to 0.97, p < 0.00001; low certainty) and recurrence (RR = 0.27, 95% Cl: 0.12 to 0.60, p = 0.001; low certainty). The analysis revealed no statistically significant difference in the incidence of complication (RR = 0.81, 95% Cl: 0.38 to 1.73, p = 0.58; very low certainty).
ConclusionThe synthesized findings suggest that endoscopic surgery combined with PRP treatment alleviates clinical symptoms and improves the quality of life in LDH patients. However, due to methodological limitations and potential heterogeneity across studies, higher-quality research is required to substantiate its efficacy and safety for LDH.