Are Same Day Low Back Disc Stem Cell Injections Effective?
In 2005-2006, our clinic was the first in the country to use same day isolated bone marrow stem cells to treat degenerative discs with a low back disc stem cell procedure. This means we took a bone marrow aspirate in the morning, isolated the stem cell fraction in our lab, and placed the cells back into the low back discs in the afternoon via an x-ray guided injection. It was a dismal failure, in that only one out of about 5-6 patients reported any significant improvement and no patient had any improvement in the status of their low back degenerative disc on follow-up research grade MRIs. We quickly moved on to more advanced procedures for the low back and after years of research developed a procedure where cells were cultured. With a lot of other small changes and refinements, we finally became convinced that the modified cultured procedure was making patients better. Recently a clinic in Colorado and a few around the country have begun to tout the magic of same day bone marrow stem cells injected into degenerated low back discs. This is basically our old 2005 disc procedure recycled, being “discovered” by physicians with little to no stem cell experience for the first time now in 2012. There’s even been a small case series published that seems to show improvements in pain. How can these two data sets be reconciled (our experience showing it doesn’t work and someone else’s experience showing it reduces pain)? To answer that question, a little more background is helpful. At a recent conference I reviewed another recent study that shows that injecting just concentrated platelets (no stem cells) into the disc also causes a similar decrease in pain. Based on our experience a number of years ago, we believe both of these procedures work by platelet growth factors (the bone marrow stem cell disc procedure uses a hefty dose of platelet rich plasma) leaking out of the disc into the epidural space and thus reducing swelling around irritated nerves. This then begs the question: why use bone marrow stem cells or platelets injected into discs, since the epidural space around these irritated nerves can be accessed a lot more easily via an epidural injection? Why not just inject the disc, after all, is it a big deal to inject a disc? Turns out it’s a very big deal, since placing a hole in the disc through injection has been associated with disc degeneration. Two studies this past few years have shown that entering a disc with a needle (unless you have a way to regenerate it) can cause problems. One showed that the x-ray contrast dyes commonly used to confirm that the needle is in the right place in the disc, can cause some level of harm to the cells in the disc. Another study seemed to show that merely penetrating the disc with a needle to perform a common diagnostic test (discography) causes the disc to degenerate faster. In addition, the risk of disc infection is very severe with injecting a disc, compared to a much lower risk of infection with an epidural injection. At this point, based on our data showing that placing same day bone marrow stem cells into the disc doesn’t work to help the disc, we would recommend against it. We believe the same effect can be had by placing platelet growth factors around the nerves without taking the much more invasive step of injecting the disc. Having said that, if a stem cell procedure has been shown to help discs on MRI (like our cultured disc stem cell procedure), it’s worth poking a hole in the disc.