Chronic Back Pain sufferers have non-invasive options

The Use of Autologous Stem Cells for the Treatment of Discogenic Back Pain

Chronic low back pain is an extremely common complaint and is so ubiquitous it is almost considered part of natural aging.  The human being is the only animal on Earth which is truly biped.  Our spines have adapted into a S-shaped curve in order to maintain the position of our head directly over our pelvis.  We are the only animal on Earth with an S-shaped spine.  Until the widespread use of antibiotics in the early 1940s, the average lifespan of a human being throughout evolution has been under 50.  Only since the 1940s has the lifespan increased to its current level of most people living into their late 70s or early 80s.  The human spine throughout evolution was never designed to last more than 50 years.  Pain in the lumbar spine can come from various sources, but most people agree the disc is the most common reason people suffer severe low back pain. 

The treatments for low back pain are many.  The enemy of your spine is gravity.  Various types of traction tables and inversion tables have been found to be useful for many people.  The problem is this relief is very temporary.  Chiropractic care and physical therapy are very helpful for many people.  In general, most care providers would recommend weight loss, core strengthening such as yoga and Pilates, and the use of non-steroidal anti-inflammatory medications to be helpful.  Avoiding extensive lifting, twisting, bending, and stooping are probably in your best interest.

The surgical treatment for chronic low back pain is lumbar fusion or, more recently, artificial disc replacement.  Traditionally lumbar fusion has involved placing screws and rods in your back to permanently eliminate motion, the rationale being if that part of your spine does not move, it will not hurt.  The clinical results of lumbar fusion compared to other areas of orthopedic surgery are generally dismal.  Published metanalysis indicate about 70% of people have some clinical improvement following a lumbar fusion, but less than 10% of these patients would be considered to be somewhat pain-free and living with a fairly normal level of function.  Thus, in general, lumbar fusion improves low back pain to some degree in only about 70% of patients.  Thirty percent of patients are either about the same or possibly worse following lumbar fusion.  Even under the best case scenario, undergoing a lumbar fusion results in permanent impairments because of the risk of adjacent level problems.  Most everyone agrees the risk for accelerated degeneration of the disc above or below a fusion is greater than what it would be had you not undergone a fusion.  The whole rationale for an artificial disc replacement is to provide pain relief without the inherent risk of rapid degeneration above and below a fusion.  The ideal candidate for a lumbar fusion is someone with instability.  This is demonstrated by developing spondylolisthesis or slippage of the spine.  Patients with this condition do much better than anyone else following a lumbar fusion.  Patients with gross lumbar instability are not candidates for an artificial disc replacement. 

The most controversial use of lumbar fusion is in patients with strictly discogenic back pain with no evidence of slippage.  Many insurance companies either will not cover a lumbar fusion for this diagnosis or only in patients with one abnormal disc.  Multi-level fusions in patients with strict discogenic back pain have fairly mediocre clinical results from surgery.  If a patient has three or more abnormal discs, many surgeons do not feel they have any surgical options since the clinical results of three- and four-level lumbar fusions are not very good.

The use of autogenous stem cells for the treatment of discogenic back pain has recently gathered intense interest.  I first became involved in injecting discs with biologics in 2010.  I was the first spine surgeon in the United States to inject a human disc with biologics.  This study has been published in the Journal of Neurosurgery Spine (Prospective Study of Disc Repair with Allogenic Chrondocytes, Coric).  We are able to publish our minimum two-year follow-up results.  I have also been involved in Phase I studies involving using another human being's mesenchymal stem cells for the treatment of discogenic back pain.  We have been utilizing autogenous stem cells to inject spine discs since 2011.  We are about to publish our results in the lumbar spine in a peer-reviewed journal. 

I am unaware of any adverse effects of utilizing your stem cells in an attempt to heal a damaged disc in the lumbar or cervical spine.  If you undergo this treatment and it does not provide you adequate pain relief, it would in no way impair your clinical results from surgery.  Generally, we have found a 70% improvement in 70% of our patients at one-year follow-up.  These results are much better than those reported with lumbar fusion.  I want to emphasize I am a fellowship-trained  board certified orthopedic spine surgeon.  I have a very busy surgical practice and feel this adds credibility to the potential use of autogenous stem cells in an attempt to avoid surgery.  A spine surgeon who is attempting to treat you without surgery has credibility.  The treatment takes about 30 minutes and is done with needles under IV sedation.  The recovery time is rapid, and we have various recommendations for your post procedure care which can be discussed to individualize a post procedure protocol.  The best candidates for this treatment are patients who have one or two abnormal discs without a lot of disc space collapse.  We utilize a classification system which has been published called the Pfirrmann classification.  Enclosed is a diagram of that.  Our best results seem to be in patients who have a Pfirrmann 6 or less disc.  We have had good results in patients with Pfirrmann 7 and even a Pfirrmann 8 disc, which is almost bone-on-bone.  However, we do not feel these are ideal candidates.  Many patients have multiple bad discs in the lumbar spine and really have no surgical options.  There are many patients whose MRI scan shows loss of hydration or desiccation in three or more discs, and these patients really have no surgical options.  Patients who are not candidates for stem cell therapy include people with symptomatic herniated discs or primarily leg pain from stenosis.  Stem cells are best at treating back pain, not radiating leg pain.

In conclusion, lumbar fusion certainly has its place in the overall treatment of patients with chronic back pain.  Lumbar fusion has its best results in patients who have instability demonstrated by spondylolisthesis or slippage of the spine.  It obviously has efficacy and indications for patients who have fractures from trauma or infections of the spine.  The patients who primarily have back pain from a discogenic etiology have the worst clinical results from lumbar fusion, especially if performed at more than two levels.  I believe stem cell therapy offers a very exciting alternative to surgery in your spine, especially a fusion.  Please visit our website Orthopedic Stem Cell Institute for more information.