Stem Cells for Degenerative Disc Disease
What is causing your back pain? It is obviously important to know so that you can get an appropriate treatment. A new study in the medical journal Pain Medicine questions the prevailing thought that the discs are a major culprit.
This is what the researchers wrote: “Between 26% and 42% of chronic low back pain is attributed to internal disc disruption of lumbar intervertebral discs. (A disc problem in the lower back).
These prevalence estimates and data characterizing discogenic pain originate largely from research at elite practices, conducted 20 years ago. With few studies since, their concordance with rates in community practice has rarely been addressed.” (They had some doubts about the numbers.) In conducting their own tests the doctors found that the prevalence of discogenic pain was not as prevalent but within confidence intervals, previously reported, (meaning within the ballpark), owing to the fact that they discovered discs as being responsible for pain 21% of the time.1
One of the great challenges in treating back pain is identifying the source of the patient’s pain. The majority of patients believe that their pain has been identified for them by their MRI as degenerative disc disease or herniated discs. However in many patients – the picture of disc degeneration is not the profile of their pain generator – it is the spinal ligaments, in other words a “sprain” is causing the problem.
This is difficult for people to understand because they see their MRI with an apparent “obvious” abnormality and – because of it – they carry with them a recommendation for surgery. Once that person has a physical examination and they understand their back pain based on ligament instability a treatment plan and realistic expectations can be discussed including the use of PRP Platelet Therapy and Stem Cell Therapy.
This is what the Mayo physicians suggest: Understanding kinematics (the movement of the spine) is essential for distinguishing between pathological conditions of spine disorders, which ultimately lead to low back pain. Is it the discs? Is it the ligaments?
The doctors were able to recommend guidelines in monitoring patient movement and especially side to side bending as indications of when discs were the problems and when the spinal ligaments were the problem allowing for more precise treatment strategies.2
- It should be pointed out that their determinations of their diagnosis is dependant on a physical examination – MRIs are not discussed.
Biomaterials for treating spinal instability instead of surgery
Research says PRP treatments need stem cell therapy to fix discs
Research has shown PRP to be effective in treating degenerative disc disease by addressing the problems of spinal ligament instability and by stimulating the regeneration of the discs indirectly (discs were not directly injected but showed increase in disc height)3 The same research cites that as in any medicine, the sooner you catch the degeneration, the better the results in patients satisfaction with the treatment. PRP is no exception. “The administration of PRP has a protective effect on damaged discs in the acute and delayed injection settings representing clinical treatment with PRP in the early versus late stages of the degenerative process. It appears that earlier intervention in the disease process would be more beneficial than PRP treatment of already severely degenerated discs.3
New research on PRP
As mentioned above Platelet-Rich Plasma has been proposed for the repair and regeneration of degenerated discs and results of research presented by international scientists in Milan in August 2015 showed that PRP is able to recover the mechanical properties of denatured discs, thereby providing a promising effective therapeutic modality.4 As we have seen PRP indirectly effects disc height and promote spinal stability.
Now combined with stem cells
"Platelet‑rich plasma (PRP) is a promising strategy for intervertebral disc degeneration (IDD). However, the short half‑life of growth factors released from PRP cannot continuously stimulate the degenerated discs. Combined use of PRP and bone marrow‑derived mesenchymal stem cells may repair the early degenerated discs in the long term for their synergistic reparative effect."5
The use of stem cell introduction in degenerative disc disease has sparked a lot of excitement. This is shown by research suggesting stem cells influence, change and regrow the disc's healing environment. 6
I invite you to explore other research on this site or to ask your questions.
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Please see my articles:
- Back and Hip pain generators – the ligaments of the pelvis and spine
- Misconceptions on the importance of MRI for spinal surgery
- Bone Marrow aspirated stem cells injected into the back
1. Verrills P, Nowesenitz G, Barnard A. Prevalence and Characteristics of Discogenic Pain in Tertiary Practice: 223 Consecutive Cases Utilizing Lumbar Discography. Pain Med. 2015 Aug;16(8):1490-9. doi: 10.1111/pme.12809. Epub 2015 Jul 27.
2. Ellingson AM, Shaw MN, Giambini H, An KN. Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. Comput Methods Biomech Biomed Engin. 2015 Sep 24:1-10. [Epub ahead of print]
3. Gullung GB1, Woodall JW, Tucci MA, James J, Black DA, McGuire RA. Platelet-rich plasma effects on degenerative disc disease: analysis of histology and imaging in an animal model. Evid Based Spine Care J. 2011 Nov;2(4):13-8. doi: 10.1055/s-0031-1274752.
4. Khalaf K, Nikkhoo M, Ya-Wen Kuo, Yu-Chun Hsu, Parnianpour M, Campbell-Kyureghyan N, Haghpanahi M, Jaw-Lin Wang. Recovering the mechanical properties of denatured intervertebral discs through Platelet-Rich Plasma therapy. Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:933-6. doi: 10.1109/EMBC.2015.7318516.
5. Wang SZ, Jin JY, Guo YD, Ma LY, Chang Q, Peng XG, Guo FF, Zhang HX, Hu XF, Wang C. Intervertebral disc regeneration using platelet‑rich plasma‑containing bone marrow‑derived mesenchymal stem cells: A preliminary investigation.. Mol Med Rep. 2016 Apr;13(4):3475-81. doi: 10.3892/mmr.2016.4983. Epub 2016 Mar 7.
6. Terzic CM, Smith J, Mauck WD, Shelerud RA, Maus TP, Yang TH, Murad MH, Gou S, Terry MJ, Dauffenbach JP, Pingree MJ8,Eldrige JS4, Mohammed K1, Benkhadra K1, van Wijnen AJ9, Qu W10. Gene. 2015 Jun 10;564(1):1-8. doi: 10.1016/j.gene.2015.03.022. Epub 2015 Mar 19.