Abstract
Spinal degenerative joint disease (DJD) is associated with lower back pain (LBP) arising from the degeneration of intervertebral discs (IVD), facet joints, intertransversarii muscles, and interspinous ligaments among other anatomical structures. To circumvent the socioeconomic burdens and often-problematic surgical options imposed by DJD therapy, cell-based biologic modalities like bone marrow aspirate concentrate (BMAC) have been investigated in pre-clinical and clinical settings, mostly for IVD degeneration (IDD), with encouraging outcomes. In this study, we evaluated the differences in therapeutic benefits of BMAC between IVD- and facet joint-originating chronic LBP. Eighteen patients diagnosed with chronic LBP met the selection criteria. Following discography and provocation testing, 13 patients tested positive and were assigned into IDD-associated LBP (1st arm), while the remaining 5 tested negative and were assigned into facetogenic LBP (2nd arm). Autologous BMAC was injected intradiscally in the 1st arm, while the 2nd arm received posterior spinal chain injections. No procedure-related serious events ensued. Clinical improvement was evaluated over 12 months based on pain and functionality questionnaires (VAS, BPI, RAND-36), opioid use, and changes in disc parameters assessed by magnetic resonance imaging (MRI). Ameliorated VAS and BPI scores differed significantly between both arms in favor of IDD patients who also took significantly less opioids. Average RAND-36 scores showed no significant difference between groups albeit a trend suggesting improvement was observed in IDD patients. MRI scans conducted on IDD patients demonstrated marked elevation in disc height and spinal canal space size without worsening disc quality. Overall, this is the first study investigating the potency of BMAC as an IDD treatment in Canada and the first globally for addressing facetogenic pain using cellular therapy.
Highlights
Lower back pain is a commonly confounding and costly health problem [1,2,3,4]
We evaluated the differences in therapeutic benefits of bone marrow aspirate concentrate (BMAC) between intervertebral discs (IVD)- and facet joint-originating chronic lower back pain (LBP)
We evaluated in this study the therapeutic effect of lumbar injection using autologous BMAC (1–5 ml per structure per level) in patients with chronic LBP
Summary
Lower back pain is a commonly confounding and costly health problem [1,2,3,4]. In Canada, at least 84% of adults experience at least 1 episode of LBP during their lifetime [5,6,7]. Behind LBP are non-anatomical and anatomical factors such as herniated discs, muscular strain, ligament strain, facet joint-mediated pain, and degenerative disc disease (DDD) [8, 9]. Anatomical LBP associated with DJD remains difficult to treat since current therapeutic regimens do not address disc regeneration, but are rather limited to symptomatic relief and/or improving spinal range of motion (ROM) to preserve patient functionality [12]. Biological modalities, such as stem cell transplantation, have been exploited in IDD with the aim of promoting disc healing and preserving spinal kinematics with minimal invasiveness [13, 14].
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