This clinical trial aims to check the safety and efficacy profile of pulsed radiofrequency (RF) neuromodulation combined with leukocyte-rich platelet-rich plasma (PRP) injections for the treatment of refractory low back pain due to multifidus dysfunction. The trial will compare two groups: one receiving standard physical therapy and the other receiving pulsed RF neuromodulation and physiotherapy.

Low back pain is a common condition, often associated with multifidus muscle dysfunction, which can result from aging, obesity, or limited movement. This dysfunction is characterized by fatty infiltration and loss of muscle function. Surgical procedures involving posterior or transpedicular screw insertion can exacerbate this issue by damaging the multifidus muscle, leading to persistent pain.

This study will investigate the effects of pulsed RF neuromodulation on the L2 and L3 segments bilaterally, with each side receiving treatment for 6 minutes. In addition, leukocyte-rich PRP will be injected into the multifidus muscle, and patients will undergo a physiotherapy regimen. The primary outcomes will be compared with those of a control group receiving only physical therapy.

Inclusion Criteria:

• Refractory low back pain due to multifidus dysfunction.
• Pain persisting for more than 6 months despite conventional treatments.
• Ability to provide informed consent.

Exclusion Criteria:

• Previous spinal surgery within the last year.
• Current use of systemic steroids or immunosuppressive medications.
• Known bleeding disorders or anticoagulant therapy.
• Pregnancy or lactation.
• Severe psychiatric or cognitive disorders.
• Any Congenital or Non-congenital disorders