Low back pain treated with disc decompression and autologous micro-fragmented adipose tissue: a case report

Background: Pathologies affecting the vertebral disk are extremely common in western industrialized countries. Although the causes can be multiple, it has been demonstrated that this disorder is associated with a degeneration of the intervertebral disk. Current therapies are focused on the relief of the symptoms but cannot repair the damage nor stop the degenerative process. Recently, new strategies for the regeneration of the intervertebral disk, such as the use of mesenchymal stem cells, have been identified.

Objective: To evaluate the efficacy and potential benefits of using autologous, micro-fragmented and minimally manipulated adipose tissue graft (Lipogems®) associated with nucleoplasty for the decompression of the disk in a patient suffering for recurrent low back pain.

Materials and Methods: Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system (Lipogems®), without the addition of enzymes or any other additives. Under radioscopic control and with Seldinger technique a minimal part of the nucleus pulposus was emptied to reduce excessive compression level inside the disk, thus creating a virtual cavity. With a specific instrument, manually rotated at 360°, heat ablation of terminal nerve fibers with a radiofrequency probe was performed. At the end, autologous micro-fragmented adipose tissue was injected into the cavity.

Results: In the immediate post injection period, the patient reported a significant decrease in pain and the disappearance of the paresthesia at the left lower limb. The ODI score at 6 months revealed a decrease of the disability, switching from 46% at baseline to 24%, i.e. from “severe” to “minimal”. The MRI at 6 months revealed a decompression of the treated disk and an increase in the signal intensity of the T2 sequences at the level of the nucleus pulposus.

Conclusions: Although this is a single case report, part of a larger study, the results are very encouraging. The decrease of the ODI score and the decompression of the disk shown by the MRI gave evidence of the efficacy and potential benefits of using micro-fragmented, autologous, and minimally manipulated adipose tissue associated with nucleoplasty for the decompression of the disk.