Injections of concentrated bone marrow aspirate as treatment for Discogenic pain: a retrospective analysis

Michael Wolff,Brian Barnes,Christopher Rathbone,Jon Mark Shillington,Shawn K Piasecki

doi:10.1186/s12891-020-3126-7

Abstract

BackgroundThere are an overwhelming number of patients suffering from low back pain (LBP) resulting from disc pathology. Although several strategies are being developed pre-clinically, simple strategies to treat the large number of patients currently affected is still needed. One option is to use concentrated bone marrow aspirate (cBMA), which may be effective due to its intrinsic stem cells and growth factors.MethodsThirty-three patients who received intradiscal injections of cBMA to relieve LBP were followed up based on Numeric Rating Scale (NRS), Oswestry Low Back Pain Disability Index (ODI), and Short Form-36 Health Survey (SF-36) scores. Patients were also subdivided into those with a pre-injection NRS > 5 and pre-injection NRS ≤ 5. The proportion of patients demonstrating at least 50% improvement (and 95% confidence intervals) from baseline at five follow-up visits for each outcome was evaluated.ResultsAt least 50% improvement in NRS was observed for 13.8, 45.8, 41.1, 23.5, and 38.9% of patients across five follow-up visits, out to 1 year. When stratified by high (> 5) versus low (≤ 5) baseline NRS scores, the values were 14.3, 45.5, 71.4, 22.2, and 44.4% among those with high baseline pain, and 13.3, 46.2, 20.0, 25.0, and 33.3% among those with low baseline pain. The 50% improvement rates across visits were 4.3, 28.6, 30.0, 22.2, and 30.8% for SF-36, and 4.2, 26.7, 36.4, 55.6, and 30.8% for ODI.ConclusionsIntradiscal cBMA injections may be effective to reduce pain and improve function. Patients with relatively higher initial pain may have potential for greatest improvement.

Highlights

There are an overwhelming number of patients suffering from low back pain (LBP) resulting from disc pathology
Based on commonly used patient reported validated outcome measures (NRS, Short Form-36 (SF-36), Oswestry Low Back Pain Disability Index (ODI)), the major finding is that intradiscal injections of concentrated bone marrow aspirate (cBMA) have the potential to reduce pain with a concomitant increase in overall patient health and function
The presentation of this retrospective data was designed to report the clinical outcomes of a single physician, it is useful to consider the similarities between these results and other larger prospective studies where cBMA and/or platelet-rich plasma (PRP) were used to treat LBP [23,24,25,26,27]

Summary

Introduction

There are an overwhelming number of patients suffering from low back pain (LBP) resulting from disc pathology. Several strategies are being developed pre-clinically, simple strategies to treat the large number of patients currently affected is still needed. Low back pain (LBP) is among the most prevalent and costly of musculoskeletal disorders. LBP is commonly pain resulting from pathological changes to the intervertebral disc (IVD) with discogenic pain being one of the main contributors to LBP [3]. The identification of non-surgical therapies with potential to treat discogenic pain at the level of the intervertebral disc could. A diminished capacity to cope with an inflammatory environment results in impaired IVD cell function, a situation that manifests as decreased proteoglycan synthesis and nuclear dehydration [4, 7, 8].

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Discussion

Conclusion