Reducing Lumbar Discogenic Back Pain and Disability with Intradiscal Injection of Bone Marrow Concentrate: 5-year Follow-up

Abstract

Background Context: Surgical treatments of discogenic lumbar back pain are fusion or lumbar artificial disc replacement. Studies comparing lumbar fusion with nonsurgical treatment found no difference in clinical results. Studies comparing lumbar fusion with lumbar artificial disc replacement have had mixed results. In a study with 12-month follow-up, our colleagues reported that intradiscal injections of autologous bone marrow concentrated cells resulted in substantial reductions in pain and disability without treatment complications or other adverse events. Purpose: This article reports a 5-year follow-up of treating lumbar discogenic back pain and disability with bone marrow concentrate. Study Design/Setting: Prospective, open-label, single-center case series. Patient Sample: The initial 26 participants were all surgical candidates according to their history of low back pain, nonsurgical treatment, and measurements of pain, disability, and disc degeneration. Outcome Measures: Visual Analog Scale of pain, and Oswestry Disability Index. Methods: Study design and clinical protocol, bone marrow collection and processing, and intradiscal injection were as previously described in the initial report. The study did not receive any outside funding. The disposable aspiration kits for the BMC injections, which cost about $20 each, were provided without charge by Celling Biosciences, Austin, Texas. Results: Of the initial 26 participants, six proceeded to surgery within 3 years of follow up. Of the remaining 20, 19 were available for follow-up at 5 years. Absolute and percentage reductions in pain and disability scores were sustained through the 5-year follow-up. No adverse events were reported through the 5 years. Conclusions: It may be reasonable to consider injecting participants who have discogenic back pain at one or two levels with bone marrow concentrate before they proceed to surgery.