Skip to main content
Erschienen in: International Orthopaedics 1/2016

01.01.2016 | Original Paper

Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up

verfasst von: Kenneth Pettine, Richard Suzuki, Theodore Sand, Matthew Murphy

Erschienen in: International Orthopaedics | Ausgabe 1/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study is to assess safety and feasibility of intradiscal bone marrow concentrate (BMC) injections to treat discogenic pain as an alternative to surgery.

Methods

A total of 26 patients (11 male, 15 female, aged 18–61 years, 13 single level, 13 two level) that met inclusion criteria of chronic (> 6 months) discogenic low back pain, degenerative disc pathology assessed by magnetic resonance imaging (MRI) with modified Pfirrmann grade of IV–VII at one or two levels, candidate for surgical intervention (failed conservative treatment and radiologic findings) and a visual analogue scale (VAS) pain score of 40 mm or more at initial visit. Initial Oswestry Disability Index (ODI) and VAS pain score average was 56.5 % and 80.1 mm (0–100), respectively. Adverse event reporting, ODI score, VAS pain score, MRI radiographic changes, progression to surgery and cellular analysis of BMC were noted. Retrospective cell analysis by flow cytometry and colony forming unit-fibroblast (CFU-F) assays were performed to characterise each patient’s BMC and compare with clinical outcomes. The BMC was injected into the nucleus pulposus of the symptomatic disc(s) under fluoroscopic guidance. Patients were evaluated clinically prior to treatment and at three, six, 12 and 24 months and radiographically prior to treatment and at 12 months.

Results

There were no complications from the percutaneous bone marrow aspiration or disc injection. Of 26 patients, 24 (92 %) avoided surgery through 12 months, while 21 (81 %) avoided surgery through two years. Of the 21 surviving patients, the average ODI and VAS scores were reduced to 19.9 and 27.0 at three months and sustained to 18.3 and 22.9 at 24 months, respectively (p ≤ 0.001). Twenty patients had follow-up MRI at 12 months, of whom eight had improved by at least one Pfirrmann grade, while none of the discs worsened. Total and rate of pain reduction were linked to mesenchymal stem cell concentration through 12 months. Only five of the 26 patients elected to undergo surgical intervention (fusion or artificial disc replacement) by the two year milestone.

Conclusions

This study provides evidence of safety and feasibility in the non-surgical treatment of discogenic pain with autologous BMC, with durable pain relief (71 % VAS reduction) and ODI improvements (> 64 %) through two years.
Literatur
5.
Zurück zum Zitat Gornet MF, Burkus JK, Dryer RF, Peloza JH (2011) Lumbar disc arthroplasty with Maverick disc versus stand-alone interbody fusion: a prospective, randomized, controlled, multicenter investigational device exemption trial. Spine 36:E1600–E1611. doi:10.1097/BRS.0b013e318217668f PubMedCrossRef Gornet MF, Burkus JK, Dryer RF, Peloza JH (2011) Lumbar disc arthroplasty with Maverick disc versus stand-alone interbody fusion: a prospective, randomized, controlled, multicenter investigational device exemption trial. Spine 36:E1600–E1611. doi:10.​1097/​BRS.​0b013e318217668f​ PubMedCrossRef
6.
Zurück zum Zitat Zigler J, Delamarter R, Spivak JM et al (2007) Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine 32:1155–1162. doi:10.1097/BRS.0b013e318054e377, discussion 1163PubMedCrossRef Zigler J, Delamarter R, Spivak JM et al (2007) Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine 32:1155–1162. doi:10.​1097/​BRS.​0b013e318054e377​, discussion 1163PubMedCrossRef
12.
Zurück zum Zitat Buchanan RM, Blashki D, Murphy MB (2014) Stem cell therapy for regenerative medicine. Chem Eng Prog 110:55–58CrossRef Buchanan RM, Blashki D, Murphy MB (2014) Stem cell therapy for regenerative medicine. Chem Eng Prog 110:55–58CrossRef
13.
Zurück zum Zitat Hernigou P, Homma Y, Flouzat Lachaniette HC et al (2013) Benefits of small volume and small syringe for bone marrow aspirations of mesenchymal stem cells. Int Orthop 37:2279–2287. doi: 10.1007/s00264-013-2017-z Hernigou P, Homma Y, Flouzat Lachaniette HC et al (2013) Benefits of small volume and small syringe for bone marrow aspirations of mesenchymal stem cells. Int Orthop 37:2279–2287. doi: 10.​1007/​s00264-013-2017-z
15.
Zurück zum Zitat Weber H, Holme I, Amlie E (1993) The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine 18:1433–1438PubMedCrossRef Weber H, Holme I, Amlie E (1993) The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine 18:1433–1438PubMedCrossRef
16.
Zurück zum Zitat Carey TS, Garrett J, Jackman A et al (1995) The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med 333:913–917. doi:10.1056/NEJM199510053331406 PubMedCrossRef Carey TS, Garrett J, Jackman A et al (1995) The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med 333:913–917. doi:10.​1056/​NEJM199510053331​406 PubMedCrossRef
21.
Zurück zum Zitat Kanayama M, Oha F, Hashimoto T (2015) What types of degenerative lumbar pathologies respond to nerve root injection? A retrospective review of six hundred and forty one cases. Int Orthop 39:1379–1382. doi:10.1007/s00264-015-2761-3 PubMedCrossRef Kanayama M, Oha F, Hashimoto T (2015) What types of degenerative lumbar pathologies respond to nerve root injection? A retrospective review of six hundred and forty one cases. Int Orthop 39:1379–1382. doi:10.​1007/​s00264-015-2761-3 PubMedCrossRef
23.
24.
Zurück zum Zitat Fritzell P, Hägg O, Wessberg P, Nordwall A et al (2001) 2001 Volvo Award winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26:2521–2532, discussion 2532–2534 Fritzell P, Hägg O, Wessberg P, Nordwall A et al (2001) 2001 Volvo Award winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26:2521–2532, discussion 2532–2534
26.
Zurück zum Zitat Coric D, Pettine KA, Sumich A, Boltes MO (2013) Prospective study of disc repair with allogeneic chondrocytes presented at the 2012 Joint Spine Section Meeting. J Neurosurg Spine 18:85–95. doi: 10.3171/2012.10.SPINE12512 Coric D, Pettine KA, Sumich A, Boltes MO (2013) Prospective study of disc repair with allogeneic chondrocytes presented at the 2012 Joint Spine Section Meeting. J Neurosurg Spine 18:85–95. doi: 10.​3171/​2012.​10.​SPINE12512
28.
Zurück zum Zitat Pettine KA, Murphy MB, Suzuki RK, Sand TT (2015) Percutaneous injection of autologous bone marrow concentrate cells significantly reduces lumbar discogenic pain through 12 months. Stem Cells 33:146–156. doi:10.1002/stem.1845 PubMedCrossRef Pettine KA, Murphy MB, Suzuki RK, Sand TT (2015) Percutaneous injection of autologous bone marrow concentrate cells significantly reduces lumbar discogenic pain through 12 months. Stem Cells 33:146–156. doi:10.​1002/​stem.​1845 PubMedCrossRef
Metadaten
Titel
Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up
verfasst von
Kenneth Pettine
Richard Suzuki
Theodore Sand
Matthew Murphy
Publikationsdatum
01.01.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 1/2016
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2886-4

Weitere Artikel der Ausgabe 1/2016

International Orthopaedics 1/2016 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.