Monday, 15 June 2020 | Michael Stehling

Stem Cell Treatment Improves Degenerative Disc Disease (DDD) and Chronic Back Pain

Degenerative disc disease (DDD) is one of the most common sources of back pain and affects approximately 30 million people every year. It can lead to a chronic debilitating condition and can have a serious negative impact on a person's quality of life. Although several structures within the spine have been identified as sources of pain, the inter-vertebral disc accounts for approx. 40-50% of all chronic lower back pain. When pain from DDD is severe, traditional non-operative treatment may be ineffective.

Recent research has shown that the injection of bone marrow stem cells into degenerating discs can halt and in some cases even reverse their degeneration. This is important, because this in turn slows down or halts the cascade of secondary problems resulting from a degenerating discs, such as chronic back pain, restricted motion, spinal cord and nerve root compression with radiating pain in arms and legs, deformation and inflammation in vertebral bodies (osteochondrosis), facet joint arthrosis and others.

Anatomy of the Inter-Vertebral Disc

Intervertebral discs are the connecting elements between vertebral bodies, and together compose the spine. They are composed of a gelatinous core, the nucleus pulposus, and a fibrous outer ring, the annulus fibrosus. The nucleus pulposus binds water though its healthy proteoglycan matrix.

Degenerative changes cause the proteoglycan matrix to degenerate, resulting in a loss of water of the nucleus pulposus, reducing its ability to act as a shock absorber between adjacent vertebral bodies. It also leads to a loss in height of the intervertebral disc, with consecutive changes such as narrowing of the neuro-foramina, through which the spinal nerve roots exit, putting them at risk of compression, with resulting sciatic pains and loss of muscle strength in the arms and/or legs. Structural derangement of the bones making up the spinal column also result from disc degeneration, leading to secondary arthrosis, loss of mobility and chronic pain.

Diagnosis of the Disc Degeneration

Typical radiographic findings of DDD include disc space narrowing, displacement of vertebral bodies, fusion of adjacent vertebral bodies, and development of bone spurs (osteophytes) originating from the affected vertebral bodies. MRI affords a grading of the degenerative process: the Pfirrmann scale. It ranges from a grade I, healthy, which shows a homogeneously white disc of normal height to a grade V, which shows an almost completely collapsed black and dehydrated disc.

In order to correctly assess secondary changes, high-resolution MRI with para-sagittal depiction of the neuro-foramina in the cervical spine and 3D-sequences after the injection of intravenous contrast agent to depict inflammatory changes is important, but not routinely performed.

At ANOVA, we have developed specific imaging protocols for degenerative disc and spine conditions to obtain all the relevant information to advise patients, what kind of treatment is best for them and what results they can expect from it.

Chronic Back Pain Resulting From Degenerative Disc Disease

Degeneration of the inter-vertebral disc can lead to cracks and tears in the annulus fibrosus. With enough pressure on the disc, parts of the nucleus pulposus can seep out through these tears and can cause result in a herniated disc. The disc prolapse, as it is also known, can result in compression of the spinal cord and/or nerve roots exiting from the spinal canal, with pain and functional deficits in arms and legs. With loss of height disc degeneration can also result in narrowing of the neuroforamina and the spinal canal, adding to the impingement of the spinal cord and nerves.

Standard Therapies of Degenerative Disc Disease are Ineffective

Standard therapies cannot halt or reverse disc degeneration. Instead of solving the underlying problem, methods such as physiotherapy, core muscle strengthening and stretching, pain killers and anti-inflammatory medication as well as mesotherapy with injections into the back muscles are employed with various success to control pain and improve the bio-mechanics of the back, often unsuccessfully.

In many cases surgery is the only resort if conservative treatment options do not provide relief within two to three months. Immediate surgery might be mandatory if there is weakness or numbness in the legs, a sign of often irreversible nerve damage.

Surgical approaches for herniated discs resulting from DDD include discectomy, the surgical removal of either parts or the whole damaged inter-vertebral disc. DDD related inflammatory changes in the adjacent vertebral bodies – a condition called active osteochondrosis – often requires spinal fusion with complete removal of the intervertebral disc and stabilization of the affected spinal segment. Spinal fusion, however, permanently impairs the bio-mechanics of the spine and leads to secondary degenerative changes in the adjacent segments.

 

Treatment of Disc Degeneration With Bone Marrow Stem Cells

Preclinical research and a number of clinical trials have shown that the injection of stem cells into degenerating discs can slow-down or even halt, at least for some time, the degeneration of the proteoglycan matrix of the nucleus pulposus and the resulting secondary pathological changes of the spine. A 2012 review from Cedars-Sinai Medical Center (Los Angeles, USA) summarizes the particular benefits afforded by the injection of BMC into degenerating discs, which results both in improved disc morphology and function.

A 2017 clinical trial has shown that the injection of just 2 ml of BMC into the nucleus pulposus of degenerating disc improved DDD significantly: After 36 months, only six out of a the treated 26 patients needed surgery.

The reduction in pain, measured by the VAS (Visual Analogue Scale), was also highly significant: It decreased from 82.1 ± 2.6 (intense, dreadful, horrible pain) before to 21.9 ± 4.4 (mild, annoying pain) 36 months after BMC treatment.

MRI scans performed one year after BMC treatment showed that 40% of patients had improved by one Pfirrmann grade and no patient worsened radio-graphically.

There were no adverse events related to marrow aspiration or injection, and this study provides evidence of safety and feasibility of intradiscal BMC therapy. The study showed that BMC injections are a minimally invasive and very effective alternative to surgery to treat low back discogenic pain.

Precision Treatment Employing CT-Guided 3D Virtual Reality

Effective treatment of degenerative disc disease requires:

  1. Precise diagnostic work-up and indication by experienced physicians
  2. Stem cell products that meet high quality standards
  3. Precision guidance of the stem cell implantation into the nucleus pulposus
  4. Sterile conditions to avoid infection

It is advised for patients to check the clinic’s procedures carefully before they undergo stem cell treatments: alleged stem cell preparations injected into the body blindly or guided by X-ray fluoroscopy might at best have no effect, at worst cause serious side effects, such as infection and nerve damage.

 

Other Novel Treatment Options Aiming at Regenerating Rather Than Removing the Inter-Vertebral Disc

Several new treatments are emerging that are still in the beginning clinical trial phases:

  • Glucosamine injections may offer pain relief for some without precluding the use of more aggressive treatment options.
  • Inter-vertebral disc annuloplasty (IDET) is an interventional procedure with which the disc is heated to 90 °C for 15 minutes with the goal to seal the disc and inactivate nerves irritated by the degeneration.
  • Invertebrate disc arthroplasty, also called Artificial Disc Replacement (ADR) or Total Disc Replacement (TDR), is a surgical procedure in which degenerated intervertebral discs are replaced with artificial ones, most frequently in the lumbar (lower) or cervical (upper) spine.
  • Microdiscectomy is a minimally invasive surgical procedure in which a portion of a herniated nucleus pulposus is removed surgically by using small surgical instruments or laser under an operating microscope with minimal incisions and minimal disturbance of the structural elements of the spine.
  • Percutaneous disc decompression is a minimally invasive, interventional procedure that reduces or eliminates a small portion of the bulging disc through a needle inserted into the disc, without requiring a surgical incision.
  • Spinal decompression is a non-invasive procedure that temporarily (a few hours) enlarges the inter-vertebral foramen (IVF) by aiding in the rehydration of the spinal discs.

Do Bacteria Play a Role in Disc Degeneration?

It has been hypothesized that Cutibacterium acnes may play a role in disk degeneration. These bacteria were repeatedly found in samples from discectomy, the surgical removal of inter-vertebral discs. Antibiotic therapy might be indicated if a silent bacterial infection is suspected. During interventinal treatments of discs, samples can be obtained for microbiological analysis and antibiotica can be directly injected into the disc.

Suffering From Back Pain? Contact us for More Information

If you are suffering from degenerative disc disease and back pain, contact us. We might be able to help you get back to a normal and pain-free life without disability. Our clinical experts can advise you how to find out what is wrong and what treatment options are best for you.

ANOVA stem cell products are manufactured in our licensed laboratory under the highest quality and safety standards which are fully compliant with German and European laws.

ANOVA employs precise guidance systems, combining CT (computed tomography) imaging with an infra-red guidance system which allows the interventional radiologist performing the stem cell implantation to “see through” the body in a 3D virtual reality display which allows the interventional instruments to be placed with millimeter precision, even deep inside the body. This enables us to get the stem cells exactly to the location where they should be whilst minimizing damage to important anatomical structures.

Learn more about your options by contacting us directly. You can either make an appointment at our clinic or talk to us via Skype or WhatsApp. Call us today; our patient Care Managers will make all necessary arrangements for you.

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