Pettine, 2015 conducted a prospective study of 26 patients suffering lumbar degenerative disc disease treated with bone marrow derived stem cells. These patients, 11 male and 15 female ranging in age from 18 to 61 years, were followed for 24 months. Their pre-procedure baseline and post-procedure pain level and functional status was measured using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The results demonstrated a 72% reduction in pain and a 67% improvement in functional status. These improvements were present at the 3 month follow-up and persisted through the 24 month study period.
None of the subjects suffered a complication related to the procedure. Pain and disability were not worsened as a result of the procedure.
The authors report that five of the study participants went on to undergo surgical fusion during the 24 month study period. Of these 5 only 1 showed an improvement in pain (VAS) or function (ODI) after the surgery.
Oehme’s review article 2015 discusses Stem cell Intra-discal treatment in both animal and human studies.
In this article there were 14 separate animal studies reviewed. In these studies, there were differences in species used, method of disc lesion generation and type of stem cells utilized. Outcomes were measured by studying treated discs microscopically and radiographically.
In 12 of 14 studies, (92%) “Degeneration was slowed or reversed” by microscopic analysis. Increased cellular matrix (proteoglycan or collagen) was demonstrated when compared to untreated controls. Radiographic analysis demonstrated positive response in 7/14 (50%) of the studies. Findings in these favorable studies demonstrated preservation of disc height or increased disc water content on MRI evaluation.
Oehme cites four clinical studies utilizing stem cells to treat humans. Three of four studies (75%) cited positive results. Positive outcomes were significant reduction in both back and radicular (sciatic or leg) symptoms. One of the cited studies by Orozco, et al found a 90% improvement in pain reduction, resulting in decreased disability and improved quality of life.
A second review by Wang, et al 2015 published in Gene, reviewed 22 animal studies of Intervertebral Disc Degeneration treated with stem cells. This was a meta-analysis of 642 studies that were pared down to include only those meeting strict criteria for credibility and exclusion of bias.
A meta-analysis uses statistical analysis to combine the results from multiple studies to increase the ability to draw a conclusion and to resolve uncertainty.
Of the studies included, 13 were identified to provide information on the change in disc height after treatment with stem cells. Greater disc height indicates a healthier disc. In those studies, the disc height index was significantly better than the controls (p<.001).
Fourteen of these studies were able to be analyzed with regard to radiographic evidence of disc improvement. Brighter signal indicates greater water content and healthier disc. MRI signal (T2 weighted images) were significantly improved in the stem cell implantation group compared to control (p <.001).
Histologic evidence (evaluation of the tissue microscopically) of disc degeneration was evaluated in 11 of these studies. Microscopic examination of treated discs compared to control yielded significant improvement (p<.001).
Lastly, collagen expression was increased in treated discs in the 9 studies which were analyzed compared to controls (p <.001).
Pettine, K., Suzki, R., Sand, T., Murphy, M., 2015. Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up. International Orthopaedics 2015: DOI 10.1007/s00264-015-2886-4
Oehme, D., Goldschlager, T, Ghosh, P., Rosenfeld, J., Jenkin, G., 2015. Cell-based Therapies used to treat Lumbar Degenerative Disc disease: A systematic review of animal studies and human clinical trials. Stem Cells Int. 2015: 946031
Wang, E., Carman, P., Smith, J., Mauck, W., Shelerud, R., Mans, T., Yang, T., Murad, M., Goy, S., Terry, M., Danttenbach, J., Pingvee, M., Eldridge, J., Nohammed, K., Benkhadra, K., Van Wijen, A., Qu, W., 2015. Efficacy of Intervertebral Disc Regeneration with Stem Cells- A systematic review and meta-analysis of animal controlled trials. Gene 564 (2015)1-8