Percutaneous injection of autologous bone marrow concentrate cells significantly reduces lumbar discogenic pain through 12 months.

Degenerative disc disease (DDD) induces chronic back pain with limited nonsurgical options. In this open label pilot study, 26 patients (median age 40 years; range 18-61) received autologous bone marrow concentrate (BMC) disc injections (13 one level, 13 two levels). Pretreatment Oswestry disability index (ODI) and visual analog scale (VAS) were performed to establish baseline pain scores (average 56.5 and 79.3, respectively), while magnetic resonance imaging was independently scored according to the modified Pfirrmann scale. Approximately 1 ml of BMC was analyzed for total nucleated cell (TNC) content, colony-forming unit-fibroblast (CFU-F) frequency, differentiation potential, and phenotype characterization. The average ODI and VAS scores were reduced to 22.8 and 29.2 at 3 months, 24.4 and 26.3 at 6 months, and 25.0 and 33.2 at 12 months, respectively (p ≤ .0001). Eight of twenty patients improved by one modified Pfirrmann grade at 1 year. The average BMC contained 121 × 10(6) TNC/ml with 2,713 CFU-F/ml (synonymous with mesenchymal stem cells). Although all subjects presented a substantial reduction in pain, patients receiving greater than 2,000 CFU-F/ml experienced a significantly faster and greater reduction in ODI and VAS. Subjects older than 40 years who received fewer than 2,000 CFU-F/ml experienced an average pain reduction of 33.7% (ODI) and 29.1% (VAS) at 12 months, while all other patients' average reduction was 69.5% (ODI, p = .03) and 70.6% (VAS, p = .01). This study provides evidence of safety and feasibility in the nonsurgical treatment of DDD with autologous BMC and indicates an effect of mesenchymal cell concentration on discogenic pain reduction.

Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up.

PURPOSE: The purpose of this study is to assess safety and feasibility of intradiscal bone marrow concentrate (BMC) injections to treat discogenic pain as an alternative to surgery. METHODS: A total of 26 patients (11 male, 15 female, aged 18-61 years, 13 single level, 13 two level) that met inclusion criteria of chronic (> 6 months) discogenic low back pain, degenerative disc pathology assessed by magnetic resonance imaging (MRI) with modified Pfirrmann grade of IV-VII at one or two levels, candidate for surgical intervention (failed conservative treatment and radiologic findings) and a visual analogue scale (VAS) pain score of 40 mm or more at initial visit. Initial Oswestry Disability Index (ODI) and VAS pain score average was 56.5 % and 80.1 mm (0-100), respectively. Adverse event reporting, ODI score, VAS pain score, MRI radiographic changes, progression to surgery and cellular analysis of BMC were noted. Retrospective cell analysis by flow cytometry and colony forming unit-fibroblast (CFU-F) assays were performed to characterise each patient's BMC and compare with clinical outcomes. The BMC was injected into the nucleus pulposus of the symptomatic disc(s) under fluoroscopic guidance. Patients were evaluated clinically prior to treatment and at three, six, 12 and 24 months and radiographically prior to treatment and at 12 months. RESULTS: There were no complications from the percutaneous bone marrow aspiration or disc injection. Of 26 patients, 24 (92 %) avoided surgery through 12 months, while 21 (81 %) avoided surgery through two years. Of the 21 surviving patients, the average ODI and VAS scores were reduced to 19.9 and 27.0 at three months and sustained to 18.3 and 22.9 at 24 months, respectively (p ≤ 0.001). Twenty patients had follow-up MRI at 12 months, of whom eight had improved by at least one Pfirrmann grade, while none of the discs worsened. Total and rate of pain reduction were linked to mesenchymal stem cell concentration through 12 months. Only five of the 26 patients elected to undergo surgical intervention (fusion or artificial disc replacement) by the two year milestone. CONCLUSIONS: This study provides evidence of safety and feasibility in the non-surgical treatment of discogenic pain with autologous BMC, with durable pain relief (71 % VAS reduction) and ODI improvements (> 64 %) through two years.

Novel Ultrasound-Guided Cervical Intervertebral Disc Injection of Platelet-Rich Plasma for Cervicodiscogenic Pain: A Case Report and Technical Note.

Ultrasound-guided needle placement into the cervical intervertebral discs using a lateral-to-medial approach is reportedly possible. Clinically, however, patients commonly present with very high uncovertebral joints or narrowed intervertebral spaces, making the method difficult or impossible. This report presents a novel ultrasound-guided needle placement technique to the cervical intervertebral discs using a more medial approach between the trachea/thyroid gland and the carotid sheath. A patient presented with neck pain radiating to the right shoulder and right-sided interscapular regions that affected his sleep and daily functioning. Physiotherapy, selective nerve root block, and percutaneous endoscopic right C7 laminotomy did not sufficiently improve his condition, which progressed to bilateral interscapular and bilateral shoulder pain. Provocative discography was performed with injection of leukocyte-poor and red blood cell-poor platelet-rich plasma to provoke the discogenic pain, which was treated with platelet-rich plasma mixed with lidocaine. The patient recovered well. A month later, there was a significant decrease in the neck disability index score from the initial 28/50 to 14, and there was a further decrease to 5 after 2 months. In conclusion, this medial approach of ultrasound-guided cervical disc needle placement is feasible, even in patients where disc access by previously described approaches is impossible.

Role of Intraoperative Disc Contrast Injection in Determining the Segment Responsible for Cervical Spinal Cord Injury without Radiographic Abnormalities.

OBJECTIVE: To determine the features of discs in spinal cord injury without radiographic abnormality (SCIWORA) by intraoperative disc contrast injection (IODCI) and to subsequently treat the responsible discs operatively. METHODS: From January 2007 to December 2011, 16 adult cases of cervical SCIWORA were enrolled in this study. The average preoperative Japanese Orthopaedic Association (JOA) score was 9.1 ± 1.8. Although preoperative imaging showed no obvious fracture or dislocation, spinal cord compression was evident in all cases. High spinal cord signals on MRI T2WI and cervical disc degeneration were present in all cases and swollen soft tissue anterior to the cervical spine in nine cases. All patients underwent anterior cervical surgeries for spinal cord compression, IODCI being performed after exposure of suspicious discs. Patients with only one ruptured disc underwent anterior cervical discectomy and fusion; those with more complex injuries underwent anterior cervical corpectomy and fusion with fixation of the ruptured segment. JOA scores, X-rays and CT scans were checked at specified intervals over an average of 24.4 months. RESULTS: Of 32 discs suspected preoperatively of being injured, 19 were identified as ruptured by IODCI. Anterior annulus fibrosus rupture was proved in 11 patients whereas the anterior longitudinal ligament was intact in all. JOA scores at 2 weeks, 3 months and last follow-up postoperatively were 13.3 ± 1.5, 14.5 ± 1.6 and 15.1 ± 1.5 respectively. The recovery rates were 53.2%, 68.3% and 75.9%, respectively. CONCLUSION: IODCI helps to determine the segment responsible for cervical SCIWORA.

Photochemically crosslinked collagen annulus plug: a potential solution solving the leakage problem of cell-based therapies for disc degeneration.

Intra-disc injection of mesenchymal stem cells (MSCs) to treat disc degeneration may lead to unfavorable complications, particularly osteophyte formation. Development of an effective method to block the injection portal, prevent the leakage of injected cells and materials and, hence, prevent osteophyte formation is of the utmost importance before MSC-based therapies can be applied in a clinical setting. Here we seek to alleviate the cell leakage problem and the associated complication osteophyte formation by developing an injectable annulus plug to block the injection portal during intra-disc delivery. Specifically, we fabricated a needle-shaped collagen plug by photochemical crosslinking and successfully delivered it intra-discally, in association with MSCs in collagen microsphere carriers, using a custom-made delivery device. The mechanical performance of the plug and its effectiveness in reducing cell leakage were evaluated ex vivo under compression and in torsion push-out tests. The results demonstrate that the plug survived physiologically relevant loadings and significantly reduced leakage and enhanced retention of the injected materials. Finally, a pilot in vivo study in rabbits was conducted to evaluate the performance of the plug. Microcomputed tomography imaging and histology revealed that the plug significantly reduced osteophyte formation. This work suggests the potential of the annulus plug as an adjunct or annulus closure device for intra-disc delivery of cells and materials.

Ozone injection for the treatment of lumbar disc herniation: a therapeutic analysis of 104 cases / 介入放射学杂志

Objective To observe the therapeutic efficacy of ozone injection in treating lumbar disc herniation. Methods One hundred and four patients with CT or MRI proved lumbar disc herniation, including 144 diseased lumbar discs, were enrolled in this study. The main complains were severe pain or numbness in the low back and lower limbs. Under the X-ray guidance, a 21 G needle was punctured into the disc, followed by an injection of 4-40 ml ozone (50 ug/ml) and 40 mg prednisolone acetate into intradiscal and paravertebral space. Results All patients were followed up for 3 to 84 months with an average time of 38 months. The last follow-up check was carried out in March of 2009. The total effective rate was 77.1%, with no occurrence of any serious complications. Conclusion The percutaneous injection of medical ozone into disc and paravertebral space is an effective and safe method for the treatment of lumbar disc herniation.

Clinical study of peridural injection on acute herniation of intervertebral disc / 中国康复理论与实践

@#ObjectiveTo explore the effect of peridural injection on acute herniation of intervertebral disc.Methods60 cases of acute herniation of intervertebral disc were divided into two groups,including 30 cases of the peridural injection treatment group and 30 cases of the traditional treatment group. The clinical symptoms and signs were assessed before and after treatment.ResultsThe peridural injection restrained pain rapidly and shorten the period of treatment. The eminent rate was 83.4%. The index and rate in improvement and efficiency of peridural injection group were higher than that of traditional group. The course of treatment in hospital in peridural injection group was shorter than that in traditional group.ConclusionsThe peridural injection has preferable clinical curative effect in herniation of intervertebral disc.