Abstract
Current studies evaluating the outcomes of an intradiscal injection of bone marrow concentrate (BMC) for lumbar disc degeneration are limited. The purpose of this review was to determine if an intradiscal injection of BMC for lumbar disc degeneration results in a statistically significant improvement in clinical outcomes. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Levels I-IV investigations of intradiscal BMC injections in symptomatic lumbar disc degeneration were included in the analysis. Modified Coleman Methodology Scores (MCMS) were used to analyze study methodological quality. Only outcome measurements used by more than 50% of included studies, with a minimum follow-up of 12 months, were eligible for final data analysis. Pre-injection and post-injection visual analog scale (VAS) and Oswestry disability index (ODI) were compared using two-sample Z-tests. Seven articles (97 subjects (47 males, 38 females, 12 unspecified), mean age 33.9 ± 14.3 years, mean follow-up 44.4 ± 25.4 months) were analyzed. Six articles were level IV evidence and one article was level II. Mean MCMS was 56.6 ± 9.1. All subjects received single injections into the nucleus pulposus of one or more affected discs. VAS (66.0 mm to 20.9 mm; p<0.001) and ODI (44.4 to 19.1; p<0.001) significantly improved following the intradiscal BMC injection. One patient (1.0%) experienced herniated nucleus pulposus (HNP) following treatment. No other complications or re-injections were reported. In conclusion, despite our skepticism regarding the efficacy of the procedure, intradiscal injection of BMC for lumbar disc degeneration resulted in statistically significant improvement in VAS and ODI with low re-injection and complication rates in the studies assessed. Given that this study is limited to level IV evidence, the findings suggest that further randomized controlled studies may be worthwhile to evaluate the true efficacy of this treatment.
Highlights
BackgroundLumbar disc degeneration is one of the most common causes of disability in the United States, felt to account for over 40% of chronic low back pain [1,2]
Three studies were performed in the United States and two studies each were performed in Japan and Spain
bone marrow concentrate (BMC) was obtained by centrifugation of 30 to 90 mL of autologous bone marrow aspiration from the iliac crest or posterior superior iliac spine (PSIS) to perform a fluoroscopy-guided injection of 2 to 3 mL of BMC directly into one or more symptomatic intervertebral discs
Summary
BackgroundLumbar disc degeneration is one of the most common causes of disability in the United States, felt to account for (directly or indirectly) over 40% of chronic low back pain [1,2]. A combination of non-surgical measures, such as bed rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and analgesic injections, is a common treatment of early disease that has been shown to decrease symptoms but not slow down the potential progression of the disease [7,8,9,10]. Surgical procedures, such as spinal fusion, are often used for treating refractory disease but are invasive, expensive, and have high rates of postoperative complications [11,12,13,14,15]
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