Platelet-Rich Plasma Injections for Refractory Sacroiliac Joint Pain: A Two-Patient Case Series.

Background: Sacroiliac joint (SIJ) pain is an important source of chronic axial low back and buttock pain. Initial treatment commonly includes activity modification, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and other nonopioid medications. Interventional treatment options may include corticosteroid injections, radiofrequency ablation, and, in selected refractory cases, SIJ fusion. Platelet-rich plasma (PRP) is an autologous biologic injectate that has been investigated as an alternative treatment for low back pain disorders, although the available literature remains limited and conflicting. Case Presentation: We present two patients with refractory SIJ pain who underwent a single PRP injection after failing conservative and interventional treatment options. The first patient was a man in his 50s with persistent SIJ pain despite physical therapy, NSAIDs, and prior corticosteroid injections targeting the SIJ. Following a single PRP injection, he reported approximately 50% sustained pain relief at three-month follow-up. The second patient was a woman in her 50s with persistent SIJ pain despite physical therapy, NSAIDs, muscle relaxants, tramadol, and previous SIJ injections. Radiofrequency ablation was considered but was not covered by her insurance, and she did not wish to proceed with SIJ fusion. Following a single PRP injection, she reported approximately 75% sustained pain relief at four-month follow-up. Conclusion: PRP injection was associated with sustained improvement in pain in two patients with refractory SIJ pain after failure of multiple conventional treatments. These cases provide additional real-world clinical observations supporting further investigation of PRP as a potential nonsurgical option for carefully selected patients with persistent SIJ pain.