Percutaneous injection of autologous bone marrow concentrate cells significantly reduces lumbar discogenic pain through 12 months.
The Regenerative Clinic's view on this research
Mr Ali Noorani “There have been three studies published for the use of bone marrow aspirate concentrate (BMAC) for discogenic back pain in the lumbar area. The three papers were published by the same group in 2014, 2016, 2017. They interestingly show the results of the same group of patients followed up at 12 months, 2 year and 3 year follow up. The paper published 2017 had a total number of 26 patients, all of which were surgical consults. These are all surgical candidates and the injections were put forward as an alternative to surgery with a 3 year follow up with the same patients. They found out that over 2000 CFU/ml (i.e. cell number) had faster and better clinical outcomes. The average pain reduction was 70% and approximately 80% have still not had surgery at 3 years, therefore they were successful in avoiding this. The study also concluded there were no adverse events related to bone marrow aspiration or injection and the study provides evidence of safety as well as good feasibility of intradiscal BMAC therapy.”
Abstract
Degenerative disc disease (DDD) induces chronic back pain with limited nonsurgical options. In this open label pilot study, 26 patients (median age 40 years; range 18-61) received autologous bone marrow concentrate (BMC) disc injections (13 one level, 13 two levels). Pre-treatment Oswestry disability index (ODI) and visual analog scale (VAS) were performed to establish baseline pain scores (average 56.5 and 79.3, respectively), while magnetic resonance imaging was independently scored according to the modified Pfirrmann scale. Approximately 1 ml of BMC was analyzed for total nucleated cell (TNC) content, colony-forming unit-fibroblast (CFU-F) frequency, differentiation potential, and phenotype characterization. The average ODI and VAS scores were reduced to 22.8 and 29.2 at 3 months, 24.4 and 26.3 at 6 months, and 25.0 and 33.2 at 12 months, respectively (p ≤ .0001). Eight of twenty patients improved by one modified Pfirrmann grade at 1 year. The average BMC contained 121 × 10(6) TNC/ml with 2,713 CFU-F/ml (synonymous with mesenchymal stem cells). Although all subjects presented a substantial reduction in pain, patients receiving greater than 2,000 CFU-F/ml experienced a significantly faster and greater reduction in ODI and VAS. Subjects older than 40 years who received fewer than 2,000 CFU-F/ml experienced an average pain reduction of 33.7% (ODI) and 29.1% (VAS) at 12 months, while all other patients’ average reduction was 69.5% (ODI, p = .03) and 70.6% (VAS, p = .01). This study provides evidence of safety and feasibility in the nonsurgical treatment of DDD with autologous BMC and indicates an effect of mesenchymal cell concentration on discogenic pain reduction.