Can Regenerative Medicine Help Degenerative Disc Disease?

I have written many articles on stem cell therapy and how they change the degenerative disease environment of the inner spine to a healing environment. When stem cells are injected into the spine or joint they initially set up a line of communication with the native immune system and begin exchanging messages. The stem cells tell the immune cells to call healing factors to the site of spinal damage and to meet them at the points where repair is needed. This is when healing begins.

A recent paper (9) from Australian researchers explains how this change of  environment works.

  • When introduced into a diseased joint or spine, stem cells display plasticity and multipotency. This is the ability to change/morph into other cell types and multiply. They also signal the native stem cells and other growth factors to regroup and begin repairing damaged joints.
  • Mesenchymal stem cell MSCs (connective tissue stem cells) suppress inflammatory T–cell proliferation and provide an anti-inflammatory effect. The treatment inhibits damaging chronic inflammation.

Is It a Simple Back Sprain or a Surgical Disc Problem?

In these and other papers and studies I will cite below, the indirect injection treatment of a degenerative discs and resulting strengthening of the spinal ligaments and tendons suggest that maybe doctors should think the patient only has a back sprain and not a disc related surgical condition.

The chronic lower back pain patient typically experiences some type of trauma or overuse to the lower back that causes injury to the iliolumbar, interspinous, and supraspinous ligaments, the ligaments that hold the pelvis to the vertebrae and spinal processes in place.

Ligaments are designed to handle a normal amount of stress that stretches them to their natural limit, returning to their normal length once the stress is removed. If additional (traumatic) stress is applied, and this stretches the ligament beyond its natural range of extension, the ligament does not return to its normal length but instead remains permanently overstretched, diminishing its integrity and attachment to the bone.

Unlike muscle tissue, ligaments and tendons have a very limited circulatory system and a poor supply of blood to regenerate them. This is why ligaments may not heal and instead can remain in a weakened and irritable inflammatory state.

Here is a remarkable statement from the medical journal Spine:
“As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their anatomy and function is missing in the literature.”(10). In other words, very few doctors are looking for a back sprain as cause of chronic low back pain.

How Stem Cell Injections Work for Herniated Discs

Because these surgical procedures and MRIs deal with the problems of the spine as being disc related, there is an assumption that our regenerative non-surgical injections of Platelet Rich Plasma and  stem cells are injected directly into the disc. This is not how our treatment works. Our treatment works by regenerating and repairing the damaged supportive tissue of the spine; the ligaments I mentioned above and the tendons at the enthesis. The enthesis is the special connective tissue that attaches the ligaments and tendons to the bones.When these supportive tissues are rebuilt, the spine sometimes does something really wonderful, it heals the pain by slowly pulling that vertebrae back into alignment and with it, the herniated bulging disc.

Research in the medical journal Stem cells translational medicine suggests that stem cells, without direct injection to the site of disc lesions in the spine, can repair disc lesions by changing the healing environment of the spine.

Highlights of this research:

  • Stem cells are effective in inhibiting disc degeneration and disc herniation by way of the complex interplay between themselves and immune system cells in achieving successful disc tissue regeneration. The stem cells regenerated the outer tissue of the disc and contained and lessened the bulge.
  • Remarkably, stem cells were able to bring more oxygen to the damaged disc and accelerate healing by reversing the low-oxygen (degenerative or dying) environment in the spine. Everything heals with more oxygen.
  • Stem cells were able to reduce or prevent herniation by suppressing the non-healing inflammation.(11)

Exploring PRP Therapy for Low Back Pain

Research has shown Platelet-Rich Plasma Therapy (PRP) to be effective in treating degenerative disc disease by addressing the problems of spinal ligament instability and stimulating the regeneration of the discs indirectly (discs were not injected directly but showed an increase in disc height).

The same research cites that as in any medicine, the sooner the degeneration is addressed, the better the results in patient satisfaction. 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.”(12)

In our research, Treatment of Chronic Low Back Pain with Platelet-Rich Plasma Injections, published in the journal Cogent Medicine (13) we wrote:

  • Platelet-Rich Plasma (PRP) is a non-invasive modality that has been used to treat musculoskeletal conditions for the past two decades. Based on our research, there were no publications that studied the effect of PRP on unresloved lower back pain. The aim of this study was to report the clinical outcomes of patients who received PRP injections to treat unresolved lower back pain.

Methods: 

  • 67 patients underwent a series one, two, or three PRP injections into the ligaments, muscle, and fascia surrounding the lumbar spine.
  • Patients who received two treatments received injections a mean 24 days apart and patients who received three treatments received injections a mean 20.50 days apart.
  • Baseline and posttreatment outcomes of resting pain, active pain, lower functionality scale, and overall improvement percentage were compared to baseline and between groups.

Results: 

  • Patients who received one PRP injection reported 36.33% overall improvement and experienced significant improvements in active pain relief.
  • These same patients experienced improvements in resting pain and functionality score, yet these results were not statistically significant. Patients who received a series of two and three treatments experienced significant decreases in resting pain and active pain and reported 46.17% and 54.91% total overall improvement respectively. In addition, they were able to perform daily activities with less difficulty than prior to treatment.

You can read more about this paper and link to the study here: Darrow research study PRP back pain

References:

1 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.
2 Marc Darrow, Brent Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-2018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461. 5/
3 An HS, Jenis LG, Vaccaro AR (1999) Adult spine trauma. In Beaty JH (Eds.). Orthopaedic Knowledge Update 6. Rosemont, IL: American Academy of Orthopedic Surgeons pp. 653-671
4 Hammer N, Steinke H, Lingslebe U, Bechmann I, Josten C, Slowik V, Böhme J. Ligamentous influence in pelvic load distribution. Spine J. 2013 Jun 5. pii: S1529-9430(13)00402-6. doi: 10.1016/j.spinee.2013.03.050.
5. Kovacs FM, Arana E (2016) Degenerative disease of the lumbar spine. Radiologia 58(1): 26-34.
6 Franz EW, Bentley JN, Yee PPS, et al. (2015) Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine 22(5): 496-502.
7 Emery DJ, Shojania KG, Forster AJ, Mojaverian N, Feasby TE (2013) Overuse of Magnetic Resonance Imaging. JAMA Intern Med 173(9): 823-825.
8 Roetman B, Schildhauer TA. [Lumbopelvic stabilization for bilateral lumbosacral instabilities: indications and techniques]. Unfallchirurg. 2013 Nov;116(11):991-9. doi: 10.1007/s00113-012-2338-1. German.
9 Davatchi F, et al. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int J Rheum Dis. 2016 Mar;19(3):219-25
10  Von Forell GA, Stephens TK, Samartzis D, Bowden AE. Low back pain: A biomechanical rationale based on “patterns” of disc degeneration. Spine (Phila. Pa 1976). 2015 May 20.
11 Cunha C, Almeida CR, Almeida MI, Silva AM, Molinos M, Lamas S, Pereira CL, Teixeira GQ, Monteiro AT, Santos SG, Gonçalves RM, Barbosa MA. Systemic Delivery  of Bone Marrow Mesenchymal Stem Cells for In Situ Intervertebral Disc Regeneration. Stem Cells Transl Med. 2016 Oct 11. pii: sctm.2016-0033.
12 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.