Treatment of Lower Back Pain with Bone Marrow Concentrate

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Treatment of Lower Back Pain with Bone Marrow Concentrate

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 7, Issue 2

Abstract

Lower back pain can be a debilitating condition that is often caused by ligament and fascial sprains, and muscle strains. Even though the diagnosis may be a herniated disc, facet arthropathy, degenerative disc disease, spinal stenosis, scoliosis, spondylosis, spondylolisthesis, or other pathology, we have found for the past twenty years, with thousands of successfully treated patients, that the actual pain generator may not even be noted in the diagnosis. With the risk of adverse complications of surgery and ineffectiveness of epidural injections, bone marrow concentrate (BMC) offers a promising treatment to treat lower back pain. BMC contains mesenchymal stem cells that have the ability to differentiate into muscle, cartilage, and bone, in addition to releasing trophic factors that enhance tissue regeneration. The four patients included in this study underwent at least one treatment of BMC injection to the entheses of muscles, fascia, and ligaments surrounding the lumbar spine. At one-year follow-up all four patients experienced a decrease in resting and active pain. Patients also reported a mean 80% total overall improvement and were able to perform daily activities with less difficulty. These encouraging results warrant further investigation of the full potential of BMC injections for lower back pain. Lower back pain (LBP) is the second most debilitating condition in US [1] and is prevalent in 19.6% of adults between the ages of 20 and 59 [2]. Patients with chronic lower back pain experience limited range of motion, pain, and decreased quality of life. Muscle strains, ligament sprains, and muscle contusions account for up to 97% of LBP in the adult population [3]. Additionally, researchers state that spinal ligaments are often neglected compared to other pathology that account for LBP [4]. This could be due to the overreliance of MRIs to guide physicians to correct diagnoses. Two studies illustrate that patients without symptomatic back pain displayed MRI abnormalities including degenerative disk changes [5,6]. Yet patients with these same diagnoses are recommended for surgery without a thorough understanding of their pain generator. Canadian researchers found that 55.7% of lumbar spine MRIs were considered inappropriate or of uncertain value to diagnosis [7]. Research is continually disproving prognosis tests in clinical application, including in recommendations for lumbar spinal fusion [8]. The drawbacks of patients undergoing unnecessary surgeries are the accompanied risks for adverse effect. Such procedures may cause serious complications such as dural tears, recurrent herniation, neurological problems, or even death [9]. A systematic review found that 16.4% of patients who underwent surgical back procedures experienced complications [10]. To avoid surgery, many patients receive steroid epidural injections for pain relief, however the efficacy of these injections have been shown to be limited and temporary if any [11]. The risk of side-effects and ineffectiveness of current treatments demonstrates a need for a noninvasive, conservative alternative to treat LBP. Bone Marrow Concentrate (BMC) is a potential therapy to improve lower back patients’ quality of life (Figure 1). BMC is a solution that contains many cytokines and growth factors but most notably contains platelets and mesenchymal stem cells (MSCs) [12]. MSCs are adult multipotent stem cells that have the ability to differentiate into different cell types such, cartilage, bone, and muscle [13]. This is a promising solution to tissue regeneration including regeneration of muscles and ligaments [14,15]. MSCs also secrete trophic factors which have anti-inflammatory properties and have been shown to promote muscle healing and growth through myogenesis of muscle progenitor cells [16-19]. Recently, MSCs were injected into patients with degenerative disc disease with reported improvement in disc quality, pain, and quality of life variables [20-22]. The patients in the present study were injected with BMC into the muscles, fascia, and ligaments surrounding the lumbar spine. It has been well documented in literature that MSCs and platelets enhance tendon and ligament healing [14,23]. In patients who were diagnosed with ligament and fascial sprains, we hypothesize that we can reduce patients’ LBP by strengthening these anatomical areas. Lower back ligament sprains have been treated with dextrose prolotherapy for the past 80 years and patients have reported improvements in pain and function [24]. We hypothesize that since BMC has greater potential for tissue regeneration that patients could see even greater improvement. In addition, some LBP is generated from excess inflammation at the sites of tendon and ligament attachment. The MSCs and platelets in BMC have been shown to have natural anti-inflammatory properties [19,25] that would suppress this excess immune response and provide patients symptomatic relief. There are no current BMC studies that demonstrate any outcomes of this treatment approach. The objective of the present pilot study is to demonstrate that local lower back BMC injections can be an effective treatment protocol in treating LBP in an appropriate population.

Authors and Affiliations

Marc Darrow, Brent Shaw BS

Keywords

Stem Cells Lower Back Pain Non-Operative Treatment Biomedical Research Biomedres Open access publishers Peer reviewed journals Special issues Biomedres â€“ ebook publishers Biomedres â€“ video publishers Biomedical Journal of Scientific & Technical Research International academic journals Open access medical and clinical research publication The Complex world of Bio-Medical Sciences Health Sciences and Bio informatics Physical Activity and Computational Biology Life Sciences in relation with Technical Advancement Special issue publishers Effective Publishers Trendy online Publishers Popular online Publishers Biomedical Research papers publishers Biomedical sciences and Technical papers repository Online Publishers

EP ID EP592699
DOI 10.26717/BJSTR.2018.07.001461
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