In 2005, we pioneered disc stem cell research as the first clinic on earth to inject stem cells into low back discs. Along the way, we’ve learned some valuable lessons about what did and didn’t work. Recently, we’re seeing a spate of clinics offering to inject stem cells into the discs of back pain patients and one of those cases in particular was quite disturbing. Understanding why that problem patient didn’t respond well to their treatment, also provides some insight into what’s possible and what’s not.
To explain why you would want to put stem cells into low back discs in the first place, it’s helpful to understand a little about the human low back disc anatomy. The intervertebral disc is a natural cushion between the back bones (vertebrae). It can degenerate due to injury or wear and tear over time, which causes it to lose height and the ability to hold onto water. This last part reduces its ability to act as a cushion and shock absorber. Lost disc height can place too much pressure on the facet joints at that level (small finger sized joints in the back of the spine) and on exiting nerves. The disc itself can also become torn and painful, causing the patient to have difficulty sitting.
Early disc stem cell research in animals demonstrated that injecting culture expanded stem cells into discs that were purposefully destroyed for an experiment caused much of the disc to grow back. This was super exciting and sexy stuff! If this worked in humans, it would literally be the holy grail of spine care. There’s just one problem… it doesn’t work in humans. We figured this out around 2007, after injecting culture expanded stem cells into the discs of many patients with moderate to severe degenerative disc disease and observing no disc regeneration. Since then, companies pursuing stem cell drugs in a vial have also found that injecting stem cells into degenerated discs doesn’t regrow them like new.
The clinic that treated the problem patient mentioned above, claims a decade of experience in using stem cells to treat the spine. Regrettably, that’s not entirely true, given their experience with injecting low back discs with stem cells is only about 3-4 years old. So how did the clinic invent more experience? It has a longer history of using bone marrow concentrate during spine surgery to help fuse low back discs with hardware. Fusing the spine in an invasive surgery that destroys the disc is very different from a regenerative medicine injection procedure, which is intended to help heal the disc.
This problem patient has two degenerated discs in his low back. One above and one below the fusion installed by the clinic above, both caused by the surgery. These discs have no tears and have lost about half of their height. This is important, as in our decade long experience in disc stem cell research, this treatment only seems to work in patients whose discs still have normal height and painful disc tears. In addition, he has disc bulges at these levels pressing on nerves, which is a problem that a same day disc injection can’t help. Given that the nerve problem is likely causing much of his pain, it’s entirely unclear why injecting stem cells into the discs would be expected to relieve pain.
The problem patient had his discs injected, not once, but three times each for a total of six injections! Why is this an issue? Because each disc injection carries with it much more risk than just a simple epidural, facet joint, or ligament injection. While a disc infection is a rare event, they are disastrous for the patient when they happen and require one or more surgeries, along with a sledgehammer of IV antibiotics delivered via a catheter into the heart. Hence, while there may be times that injecting the disc makes good sense, it’s a procedure that should only be attempted after other less invasive injection treatments have failed.
For this type of patient, the biggest issue is overload above and below the fusion. This is because the fusion surgery made his spine bones fixed without motion. That motion must come from someplace, so every time the patient moves, he’s trying to obtain all of his low back spine movement not from the 5 low back discs as nature intended, but from the two he has left that still move.Those discs are under immense pressure and have become unstable. So the focus of care should be on using regenerative procedures to stabilize this area by injecting the ligaments and not the discs. The nerves and joints at these two levels are being beat up as well, so regenerative injections should also be focused there. Regrettably, the surgeon that injected his discs didn’t have the knowledge, nor equipment, to use advanced platelet therapies to target the ligaments, nerves, and discs. To learn more about how we approach the spine with stem cells and platelet injections, see the video to the right.
As you might imagine, this patient never got much relief despite 6 injections into his discs. This makes sense, as the other problems created by the fusion were never treated. He has now come to Regenexx for answers.
The upshot? We’ve seen great success with stem cell injections into the disc when the right patients are chosen. For painful discs with tears (patients that can’t sit), same day stem cells injections can be a life saver. In our decade long experience, we have found that specially cultured stem cells can also get rid of disc bulges in the right patients. Having said that, no amount of stem cells will regenerate a collapsed and severely degenerated disc. Finally, there’s a lot more to treating the spine than just the disc. Regenerative medicine can be used to treat facet joints, SI joints, nerves, ligaments, muscles and more with great success and without ever treating the disc itself. As far as our problem patient is concerned, our goal is to help this patient deal with the awful side effects of his fusion. That’s unlikely to involve injecting his disc for the 7th and 8th time!
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…