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What a Decade of Disc Stem Cell Research Has Taught Us

POSTED ON IN Back/lumbar Regenexx-DDD Regenexx-PL Disc BY Chris Centeno

disc stem cell research and findings

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.

Stem Cells and Discs in Animal Research

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.

Is Using Bone Marrow to Promote Spine Fusion the Same as Disc Stem Cell Therapy?

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.

If at First You Don’t Succeed…

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!

 

    comments

    Diana Carnes says

    What is your experience with patients who have been injected with euflexxa? It is not, as I mistakenly thought, a regenerative agent but is more of a lubricant. Would having been injected with it preclude stem cells later?

    replies

    Regenexx Team says

    Diana,
    You're right, it's an attempt to replace or augment the synovial fluid in the joint, with no regenerative potential. A bit like WD40. No, it is not a problem for stem cells later.

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    Patrick Simoniello says

    My wife was involved in a bad car accident about 5 years ago breaking many bones and leaving her spine and frame somewhat twisted and last year began suffering severe hip pain and was seeing a chiropractor who's x rays showed a bone on bone hip condition.. Our doctor and a surgeon recommended a hip replacement. I decided to try the regenexx liquid, after a few months she became pain free and so now we both have been taking it every morning since we are both in our late seventies. We have not confirmed by x ray or MRI if new cartilage has formed in her hip but we assume it has since she is pain free now and were wondering if that might be the case? Does the liquid regenexx regrow new cartilage?

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    Regenexx Team says

    Patrick,
    That is such wonderful news! Thank you for sharing it! We put a year's worth of lab research into what ingredients and at what ratios had the most positive effect possible on cartilage and stem cells and many, many people have reported similar results. http://www.regenexx.com/regenexx-stem-cell-supplement/ However, yours made my day!

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    allan oconnor says

    hy! allan oconnor here, in grand rapids michigan.. i know that there is regenexx clinic in toledo ohio, but is there
    any regenexx clinic or associates in grand rapids michigan or any cities close to grand rapids, thanks much, allan

    replies

    Regenexx Team says

    Allan,
    Here is the link into which you can put your city and state or zipcode to find the Regenexx Provider closest to you. When I put in Grand Rapids, Michigan, it looks like our 2 Chicago Providers are closer: http://www.regenexx.com/find-a-physician/

    replies

    allan oconnor says

    all the information you've put on line is very valuable thanks alot, its appreciated

    replies

    Regenexx Team says

    Thanks Allan...we appreciate you saying so!

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    Dr. Greg Castello says

    I'm a Family Doc, new to prolo/PRP/stem cells. I have near bone on bone DDD at L4-L5 with near bridging vertebral body ostephytes, and started Prolo with the hope of doing stem cells intra discal, but the article implies I am a lost cause. I'm 49, in great shape otherwise and play in 2 men's baseball leagues, and not ready to accept a fusion.
    My thought was an anterior approach spur debridement and some type of elevation stabilization like Dynisys or Coflex, then with the disc decompressed, do stem cells. Any thoughts?

    replies

    Regenexx Team says

    Dr. Costello,

    I've forwarded your question to Dr. Centeno.

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    Regenexx Team says

    "Greg, we have no human data at all that stem cells will repopulate your disc and reconstitute it in the procedure your describe. Given that these are posterior stabilization systems that are designed to work with an intact disc by taking some of the load from the anterior column and moving it posterior, it's unknown if that would help your disc when stem cells are added or just lead to device failure. In addition, both of these systems reduce motion substantially, so given the rationale for regenerating a disc is to keep your natural motion at that level, these systems would defeat that purpose. In summary, with a completely collapsed disc, I think your best option is to use the prolo to stabilize the segment as much as possible. I would make sure the prolo you're getting is performed under guidance." ~ Dr. Centeno

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    Dr. Greg Castello says

    Dr Centeno. Yes, those are posterior approach devices, I'm afraid that without debridement of the sharp ostephytes, my pain wouldn't be improved. My hopes, and I'm sure you have no data, are to do a stabilization procedure, then add stem cells to a more stable, decompressed disc, then in 1-2 years, have the hardware removed. My joy is baseball, I play on 2 teams 18 and 25 year old, I am 49. I cannot play with my current pain level, and I don't think sliding into a base with a fusion is a good idea.
    The concensus at a recent prolo conference was that prolo would not fix me....and don't do fusion. I have a couple interesting images from my CT if there is a way to post it.
    I appreciate and respect the work you are doing. I am amazed, that as a DO in practice for 20 years, that I am just now learning about this field. Keep up the good work.

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    Regenexx Team says

    Dr. Costello,
    I have forwarded your note to Dr. Centeno. He is on vacation though, so not sure when he will reply.

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    Dr. Greg Castello says

    When you inject stem cells intradiscal, what type of concentration are you acheving? Much different than a knee, the disc probably can't accept more than 1cc volume, so do you do a different process to boost the total number of stem cells?

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    Regenexx Team says

    Dr. Costello,
    Depending, Regenexx-C, the cultured procedure only available in Grand Cayman is often used.

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    Need-help says

    Hi,
    Can you clarify that after 2007 where Dr Chris realized that stem cells arent helping in disc regeneration, what changed which made him believe in the regenerative ability of the stem cells ?
    Can stem cells heal annular tear ? Is there any MRI evidence?
    Mesoblast is using hyaluronic acid carrier with stem cells and their study is in stage 3. Has regenexx tried any carriers with stem cells like human growth hormone, hyaluronic acid ?
    All those who have spine issues need your help so please keep researching for us and please make it cheaper for those who cant afford it.
    Prayers

    replies

    Tommy Kirby says

    Tommy Kirby here.

    I'm a little over 75. Have had facet steroid shots
    that helped for a little while. Had a physician mix some
    steroids & give a series of shots over a 3 week period..No good
    for any length of time. Now going to a neurologist in Odessa Fl
    who I think is brilliant & after I go to a chiropractor, & then do the MRI,
    He will evaluate to see if I'm a candidate. major problem is the dreaded DDD.
    Pull for me as I need to get back on the golf course & get some of my money back.
    I am enjoying reading your PDF. Extremely informative & interesting.
    .

    replies

    Regenexx Team says

    Tommy,
    To get back on the golf course it's very important to avoid the steroid shots! They are very damaging to the native stem cells in all joints. They have the potential to escalate the problem drastically. The DDD is treatable and that would be the best place to intervene: http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ http://www.regenexx.com/regenexx-ddd/

    replies

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    About the Author

    Chris Centeno

    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.…

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