Spine

Harnessing Your Body’s Ability To Heal

Dr-Jeffrey-Larson-Neurosurgeon

Regenerative medicine is a tissue engineering and molecular biology process, which “replaces, engineers, or regenerates human cells, tissues or organs to restore or establish normal function”. Advances in Regenerative Medicine, including cell therapy using mesenchymal stem cells (MSCs), are emerging as promising treatments for various degenerative conditions of the shoulder, hips, knees, and spine. Low back pain can now be treated with cell therapy using your body’s own cells to promote healing.

Studies show that adipose tissue cells can have the ability to reduce inflammation and provide important proteins that may promote healing, particularly at the site where they are injected.

The discs in your spine act as shock absorbers for your body. Over time and as a normal part of the aging process the discs may wear out or become degenerative. The pathogenesis of degenerative disc disease involves a cycle of biomechanical factors and extracellular matrix breakdown that leads to cell death. Symptoms include chronic lower back pain and symptoms radiating into the lower extremities. This degenerative cascade can now be treated with regenerative medicine techniques including cell therapy.

Stem cells are present in all of us and they act as a repair system for the body. The goal of adipose cell therapy for back pain is to enhance the natural repair system of your body by injecting fat, taken from your body, into the degenerative disc or joints. Fat, taken from your own body, has the potential benefit of halting or reversing the degenerative cascade associated with degenerative discs. They do this by exerting an anti-inflammatory response and altering the immune response of injury or degenerative disc disease. MSC therapy may slow the process of degenerative disc disease and in doing so offer relief of back pain.

If you are considering Regenerative Medicine options for your lower back pain, schedule an appointment at CDA Regenerative Medicine see if you are a candidate for this or other treatment options. 

Conditions Treated with Cell Therapy

  • Degenerative disc disease
  • Disc herniation
  • Spondylosis
  • Facet joint pain
  • SI joint pain
CDA-Regenerative-Medicine-Spinal-Dr-Jeffrey-Larson

Scientific Articles

Autogenic mesenchymal stem cells for intervertebral disc regeneration
 2019 Apr;43(4):1027-1036. doi: 10.1007/s00264-018-4218-y. Epub 2018 Nov 10.

Author information

1Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com.2Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.3Department of Spine Surgery, Eifelklinik St. Brigida, Kammerbruchstraße 8, 52152, Simmerath, Germany.

Autogenic mesenchymal stem cells for intervertebral disc regeneration

Abstract

PURPOSE:

A systematic review of the literature was conducted to clarify the outcomes of autologous mesenchymal stem cells (MSC) injections for the regeneration of the intervertebral disc (IVD).

METHODS:

The following databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar bibliographic databases. Articles including previous or planned surgical interventions were excluded. Only articles reporting percutaneous autologous MSC injection to regenerate IVD in humans were included. We referred to the Coleman Methodology Score for the methodological quality assessment. The statistical analysis was performed using Review Manager Software 5.3.

RESULTS:

After the databases search and cross-references of the bibliographies, seven studies were included in the present work. The funnel plot detected low risk of publication bias. The Coleman Methodology Score reported a good result, scoring 61.07 points. A total of 98 patients were enrolled, with 122 treated levels. All the patients underwent conservative therapies prior to injection. A remarkable improvement in the quality of life were reported after the treatment. The average Oswestry Disability Index (ODI) improved from “severe disability” to “minimal disability” at one year follow-up. The visual analogue scale (VAS) showed an improvement of ca. 30% at one year follow-up. Only one case of herniated nucleus pulposus was reported. No other adverse events at the aspiration or injection site were observed.

CONCLUSIONS:

This systematic review of the literature proved MSC injection to be a safe and feasible option for intervertebral disc regeneration in the early-degeneration stage patients. Irrespective of the source of the MSCs, an overall clinical and radiological improvement of the patients has been evidenced, as indeed a very low complication rate during the follow-up.

KEYWORDS:

Intervertebral disc degeneration; Low back pain; Mesenchymal stem cells; Regenerative medicine; Spine

PMID:30415465
DOI: 10.1007/s00264-018-4218-y
Stem Cell Therapies for Treatment of Discogenic Low Back Pain: a Comprehensive Review
 2019 Jul 29;23(9):65. doi: 10.1007/s11916-019-0804-y.

Author information

1Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu.2Georgetown University School of Medicine, Washington, DC, USA.3University of Pennsylvania School of Medicine, Philadelphia, PA, USA.4Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.5Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.6Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.7Department of Anesthesiology, School of Medicine, Creighton University, Omaha, NE, USA.8Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA.9Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.

Stem Cell Therapies for Treatment of Discogenic Low Back Pain: a Comprehensive Review

Abstract

PURPOSE OF REVIEW:

Discogenic low back pain (DLBP) stems from pathology in one or more intervertebral discs identified as the root cause of the pain. It is the most common type of chronic low back pain (LBP), representing 26-42% of attributable cases.

RECENT FINDINGS:

The clinical presentation of DLBP includes increased pain when sitting, coughing, or sneezing, and experiencing relief when standing or ambulating. Dermatomal radiation of pain to the lower extremity and neurological symptoms including numbness, motor weakness, and urinary or fecal incontinence are signs of advanced disease with disc prolapse, nerve root compression, or spinal stenosis. Degenerative disc disease is caused by both a decrease in disc nutrient supply causing decreased oxygen, lowered pH, and lessened ability of the intervertebral disc (IVD) to respond to increased load or injury; moreover, changes in the extracellular matrix composition cause weakening of the tissue and skewing the extracellular matrix’s (ECM) harmonious balance between catabolic and anabolic factors for cell turnover in favor of catabolism. Thus, the degeneration of the disc causes a shift from type II to type I collagen expression by NP cells and a decrease in aggrecan synthesis leads to dehydrated matrix cells ultimately with loss of swelling pressure needed for mechanical support. Cell-based therapies such as autologous nucleus pulposus cell re-implantation have in animal models and human trials shown improvements in LBP score, retention of hydration in IVD, and increased disc height. Percutaneously delivered multipotent mesenchymal stem cell (MSC) therapy has been proposed as a potential means to uniquely ameliorate discogenic LBP holistically through three mechanisms: mitigation of primary nociceptive disc pain, slow or reversal of the catabolic metabolism, and restoration of disc tissue. Embryonic stem cells (ESCs) can differentiate into cells of all three germ layers in vitro, but their use is hindered related to ethical concerns, potential for immune rejection after transplantation, disease, and teratoma formation. Another similar approach to treating back pain is transplantation of the nucleus pulposus, which, like stem cell therapy, seeks to address the underlying cause of intervertebral disc degeneration by aiming to reverse the destructive inflammatory process and regenerate the proteoglycans and collagen found in healthy disc tissue. Preliminary animal models and clinical studies have shown mesenchymal stem cell implantation as a potential therapy for IVD regeneration and ECM restoration via a shift towards favorable anabolic balance and reduction of pain.

KEYWORDS:

Degenerative disc disease; Discogenic pain; Embryonic stem cells; Low back pain; Mesenchymal stem cells; Nucleus pulposus transplantation

PMID: 31359164

DOI:10.1007/s11916-019-0804-y

Intervertebral disc regeneration with an adipose mesenchymal stem cell-derived tissue-engineered construct in a rat nucleotomy model
 2019 Mar 15;87:118-129. doi: 10.1016/j.actbio.2019.01.050. Epub 2019 Jan 25.

Author information

1Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.2Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: takashikaito@ort.med.osaka-u.ac.jp.3Division of Intelligent Mechanical Systems, Faculty of System Design, Tokyo Metropolitan University, 6-6, Asahigaoka, Hino, Tokyo 191-0065, Japan.4Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Sensory & Motor System Medicine, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan.5Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka 586-8521, Japan.6Department of Orthopaedics, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA.7McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.8Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27, Tennma, Kita-ku, Osaka 530-0043, Japan; Center for Advanced Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan.

Intervertebral disc regeneration with an adipose mesenchymal stem cell-derived tissue-engineered construct in a rat nucleotomy model

Abstract

Low back pain results in more global disabilities than any other condition, and intervertebral disc (IVD) degeneration is commonly involved in the etiology. Supplementation of IVDs with reparative cells is a rational strategy to address such clinical problems. We have previously developed a scaffold-free tissue-engineered construct (TEC) as a novel cell therapy system for repair of articular cartilage and meniscus. We now show the regenerative potential of adipose mesenchymal stem cells derived TEC (ADSC-TEC) for IVD degeneration using a rat tail model of total nucleotomy. The regenerative efficacy of ASDC-TEC was investigated structurally and biomechanically up to 6 months after implantation. ADSC-TEC implantation into IVDs preserved the disc height, endplate, and annulus fibrosus structure, and showed similar biomechanical characteristics to the sham group at postoperative 6 weeks. The structure of regenerated IVD was maintained until 6 months. Furthermore, ADSC-TEC implantation attenuated the impact of age-related biomechanical deterioration when assessed at 6 months post-implantation. These results demonstrate that use of ADSC-TECs can be an effective treatment for IVD degeneration. STATEMENT OF SIGNIFICANCE: We developed adipose mesenchymal stem cell-derived scaffold-free tissue engineered construct (ADSC-TEC) as a novel cell therapy system. The ADSC-TEC implantation into a rat total-nucleotomized disc space regenerated intervertebral discs (IVDs) histologically and biomechanically. The regenerative capacity of the ADSC-TEC was exerted by its trophic effects on annulus fibrosus cells and the load-sharing effect at intervertebral space. Interestingly, the regenerated IVDs by the ADSC-TEC was less susceptible to the age-related deterioration than the IVDs of normal rats. Thus, the application of ADSC-TEC into the degenerated disc can be an alternative therapy for various disease associated with structural and functional failure of IVDs.

KEYWORDS:

Biomaterials; Intervertebral disc; Mesenchymal stem cells; Regeneration; Total nucleotomy

PMID: 30690206
DOI: 10.1016/j.actbio.2019.01.050