Back/Spine – Arthritis/Joint Disorders – Adipose

For a successful spinal fusion to occur, several vital elements are necessary. They consist of the presence of the bone-forming cell (osteoblast) or its precursor, the appropriate biological signals directing bone synthesis, and a biocompatible scaffold on which the process can occur. The most critical of these components is the osteoblast or its precursor, the mesenchymal stem cell (MSC), both of which possess the ability to form bone. As a result, many current techniques attempt to maximize the benefits derived from harvesting the ready source of MSCs from bone marrow, while minimizing the associated complications. These cellular technologies seek to improve on the harvest and concentration of the MSCs or enhance their delivery and action. This review focuses on the terminology, historical underpinnings, and current research rationale and techniques and discusses the possible future of these technologies.

Click here to read the full article.

Low back pain is a universal and disabling chronic condition that has significantly contributed to rising health care costs. IVD degeneration is the leading cause of back pain and is also often the precursor to the degenerative cascade of facet arthropathy, spinal deformity, and stenosis. Treatments targeting the painful annular fissures early on may also help prevent progression of spinal deformity and disability. Interventions that hinder ongoing cell degradation or that supplement anabolic cell production are necessary cost-effective treatments for low back pain, as the current epidural injection options offer only transient relief and current surgical options cost exorbitantly Regenerative Treatments for Spinal Conditions 1013 more. Surgeries themselves may contribute to adjacent-level degeneration, as seen in spinal fusions .58 Regenerative treatments may also offer a great solution for those refractory to pain management and injections and those who prefer to avoid surgery. The existing translational and clinical studies presented in this article provide supportive evidence for regenerative treatments for discogenic pain, including intradiscal PRP, mesenchymal stem cell, and fibrin treatments. These studies are paving the way to the future of spine medicine, which is shifting toward regenerative biologic treatments and away from spinal fusion surgeries for discogenic low back pain.

KEY POINTS

• Low back pain is a common and expensive cause of disability.
• Nonhealing annular fissures are the most common cause for low back pain.
• Early treatment of painful annular fissures may also help prevent progression to spinal
  deformity, stenosis, and disability.
• Intradiscal platelet rich plasma, mesenchymal stem cells, and fibrin are promising therapeutic options for intervertebral disc degeneration.
• Regenerative treatments may offer a more cost-effective solution for refractory discogenic pain and perhaps avoid expensive surgery altogether. 

Click here to read the full article.

Background:

Several cell-based therapies have been proposed in recent years the management of low back pain, including the injection of medicinal signaling cells or mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP). However, there is only emerging clinical evidence to support their use at this time.

Purpose:

To assess the effectiveness of MSCs or PRP injections in the treatment of low back and lower extremity pain.

Study Design:

A systematic review and metaanalysis of the effectiveness of PRP and MSCs injections in managing low back and lower extremity pain.

Data Sources:

PubMed, Cochrane Library, US National Guideline Clearinghouse, prior systematic reviews, and reference lists. The literature search was performed from 1966 through June 2018.

Study Selection:

Randomized trials, observational studies, and case reports of injections of biologics into the disc, epidural space, facet joints, or sacroiliac joints.

Data Extraction:

Data extraction and methodological quality assessment were performed utilizing Cochrane review methodologic quality assessment and Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) and Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR). The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5.

Data Synthesis:

Twenty-one injection studies met inclusion criteria. There were 12 lumbar disc injections, 5 epidural, 3 lumbar facet joint, and 3 sacroiliac joint studies

Results:

Evidence synthesis based on a single-arm metaanalysis, randomized controlled trials (RCTs), and observational studies, disc injections of PRP and MSCs showed Level 3 evidence (on a scale of Level I through V). Evidence for epidural injections based on single-arm metaanalysis, a single randomized controlled trial and other available studies demonstrated Level 4 (on a scale of Level I through V) evidence. Similarly, evidence for lumbar facet joint injections and sacroiliac joint injections without metaanalysis demonstrated Level 4 evidence (on a scale of Level I through V)..

Limitations:

Lack of high quality RCTs.

Conclusion:

The findings of this systematic review and single-arm metaanalysis shows that MSCs and PRP may be effective in managing discogenic low back pain, radicular pain, facet joint pain, and sacroiliac joint pain, with variable levels of evidence in favor of these techniques.

Click here to read the full article.