Regenexx Blog
by Chris Centeno, MD / August 19, 2019

https://regenexx.com/blog/stem-cell-...for-back-pain/

Does stem cell therapy for back pain actually work? If so, can stem cell therapy work for degenerative disc disease? What kinds work better than others? Is stem cell therapy covered by insurance? Letís dig in.

My Street Cred on Stem Cell Therapy for Back Pain
Back in 2005, I was one of the first humans on earth to inject stem cells into a human disc. In the past almost two decades Iíve published and learned much about what works and doesnít work. My goal here is to make sure that I transfer that wisdom to you to keep you from getting scammed.

Back Pain is Caused by Lots of Things
Before we jump into stem cell therapy for back pain, itís critical to review what the targets for the therapy would be. Meaning, what causes back pain? Lots of things:

Bulging or herniated discs that irritate or compress nerves
Arthritic facet joints-there are two of these at each spinal level (7)
Degenerative Disc Disease (DDD)-The disc cushioning the backbones gets degenerated and collapses (8)
Spinal stenosis-The holes in the backbones that pass nerves get too small and place pressure on nerves
Loose Ligaments around the Sacroiliac Joint (6)
Muscle trigger points or atrophied stabilizing muscles (5)

Stem Cell Therapy for Back Pain
Itís critical when looking for the right stem cell therapy for back pain that you follow the Who, What, and Where method. If you donít, youíre more likely than not to get scammed. So how does that work?

Who will perform the injection?
What will be injected?
Where will it be injected?

Who will perform the stem cell therapy for back pain is critical. Given that the stem cells need to be placed into specific spots that are causing pain and this requires advanced imaging guidance and training to do safely, getting this injection procedure done by a nurse or physicianís assistant or even a non-specialist family physician just isnít a viable option. You need a spine specialist who can perform precise injections using an x-ray technology known as fluoroscopy.

What will be injected is also critical. As an example, a common message youíll hear at seminars is that the clinic uses young and vibrant stem cells from amniotic fluid or umbilical cords! Thereís just one problem with that message and itís called reality. Meaning multiple studies have now shown that the products used by these clinics contain no live and viable stem cells, in fact, these preparations theyíre using are all dead tissue (1-3). In fact, the only stem cell therapy out there right now that can be performed in the United States is Bone Marrow Concentrate (BMC) from the same patient, which contains many live and viable mesenchymal stem cells (4). BMC is obtained from a bone marrow aspirate at the back of the pelvis, centrifuged to concentrate the stem cell fraction, and then reinjected. Other possibilities include using cells that are cultured and grown to bigger numbers.

Where will the stem cells be reinjected? As discussed above, that could be many different areas from into the disc, around the nerves (epidural), into the facet joints, ligaments, muscles, etcÖ Injecting stem cells into the wrong area will provide no results, so being able to diagnose where cells should go and then getting the cells to that specific area is critical.

Want to learn more about choosing a good stem cell clinic using this who, what, and where system? Click on the cover below to read that short mini-book:

stem cell clinic guide https://3n30av2dln0g4fmlc03hpv0p-wpe...and-How-v3.pdf

Research: Does Stem Cell Therapy Work for Back Pain?
Has medical research demonstrated that stem cell therapy for back pain is effective? To answer that question, Iíll include all regenerative medicine therapies, such as platelet-rich plasma (concentrated platelets from the patients own blood), bone marrow concentrate, and cultured stem cells (not available in the United States).

Thereís pretty good research that platelet-rich plasma (PRP) can help various causes of back pain. For example, there is a high-level study showing that PRP can help painful low back discs (9). We published a research study on using a type of PRP called platelet lysate to help sciatica caused by bulged and herniated discs (10). In addition, PRP has been shown to help reduce the atrophy of low back stabilizing muscles as well (11). Finally, PRP has also been used to treat sacroiliac joint problems and was shown to better than steroid shots (12).

Next up is bone marrow concentrate. This has been used successfully to treat painful discs through injection (13). Practically, we have also used it to treat damaged facet joints, sacroiliac joint instability/pain, as well as degenerative disc disease. However, the sweet spot appears to be in treating painful disc tears that often reduce the ability of the patient to sit for any prolonged period of time.

While not legal in the United States, in other countries, the patientís bone marrow stem cells can be cultured and grown to larger numbers. We have published on injecting these types of cells to treat bulging discs causing nerve root impingement (14, 15). There are a few others who have also published on a smaller number of patients.

Notice what you donít see in this section. There are no human studies on using amniotic or umbilical cord products in the spine. There is also nothing published in human patients where exosomes were used (a type of therapy beginning to be offered). Hence, if you go to a seminar that claims that there is copious research showing these things work well in real patients, then run.

Does Stem Cell Therapy Work for Degenerative Disc Disease?
One of the more common questions I get from patients on stem cell therapy for back pain is whether it can regrow a collapsed low back disc. The discs in the spine are cushions that sit between individual backbones (vertebrae). In DDD the disc collapses and this causes degenerative instability which can lead to facet joint arthritis, irritated nerves, and over the long run, stenosis.

So can stem cell therapy for back pain regrow a degenerated disc? There was a real promise that this would happen, as in animals like rabbits, this is easy to do (16). However, to date, in humans, reliable disc regeneration has remained elusive. Meaning that it is very unlikely that if you have a collapsed disc, injecting stem cells will grow you a new plump disc.

Navigating What Works for Which Problem
I created a little video on this topic, so please watch this for more information:

https://youtu.be/QNiTUSqIZzc

In addition, I wrote a whole book on this topic of stem cells for spine problems, click on the cover below to download a copy:
https://regenexx.com/resources/ebook...owners-manual/

Is Stem Cell Therapy Covered by Insurance?
Regrettably, for most patients, stem cell therapy for back pain is not covered by major health insurers, Medicare, or Medicaid. However, Regenexx has had success in getting full coverage from various self-funded health plans. Click here to learn more about getting your employer to cover these procedures.

The upshot? Stem cell therapy for back pain is a promising alternative to surgery. However, making sure you actually get the real deal versus treatment with dead stem cells may take some homework!

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References:

(1) Berger D, Lyons N, Steinmetz, N. In Vitro Evaluation of Injectable, Placental Tissue-Derived Products for Interventional Orthopedics. Interventional Orthopedics Foundation Annual Meeting. Denver, 2015. https://interventionalorthopedics.or...cts-Poster.pdf

(2) Becktell L, Matuska A, Hon S, Delco M, Cole B, Fortier L. Proteomic analysis and cell viability of nine amnion-derived biologics. Orthopedic Research Society Annual Meeting, New Orleans, 2018. https://app.box.com/s/vcx7uw17gupg9ki06i57lno1tbjmzwaf

(3) Panero, A, Hirahara, A., Andersen, W, Rothenberg J, Fierro, F. Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison. The American Journal of Sports Medicine, 2019 47(5), 1230Ė1235. https://doi.org/10.1177/0363546519829034

(4) Gianakos AL, Sun L, Patel JN, Adams DM, Liporace FA. Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review. World J Orthop. 2017;8(6):491Ė506. Published 2017 Jun 18. doi:10.5312/wjo.v8.i6.491

(5) Kalichman L, Carmeli E, Been E. The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain. Biomed Res Int. 2017;2017:2562957. doi:10.1155/2017/2562957

(6) Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537Ė567. doi:10.1111/j.1469-7580.2012.01564.x

(7) Manchikanti L, Hirsch JA, Falco FJ, Boswell MV. Management of lumbar zygapophysial (facet) joint pain. World J Orthop. 2016;7(5):315Ė337. Published 2016 May 18. doi:10.5312/wjo.v7.i5.315

(8) White, A. A., & Panjabi, M. M. (1978). Clinical biomechanics of the spine. Philadelphia: Lippincott.

(9) Monfett M, Harrison J, Boachie-Adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int Orthop. 2016 Jun;40(6):1321-8. doi: 10.1007/s00264-016-3178-3.

(10) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi:10.1186/s40634-017-0113-5

(11) Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2016;2:12. Published 2016 Mar 22. doi:10.1051/sicotj/2016002

(12) Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526

(13) Pettine KA, Suzuki RK, Sand TT, Murphy MB. Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up. Int Orthop. 2017 Oct;41(10):2097-2103. doi: 10.1007/s00264-017-3560-9.

(14) Centeno C, Markle J, Dodson E, et al. Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: a pilot study on safety and efficacy. J Transl Med. 2017;15(1):197. Published 2017 Sep 22. doi:10.1186/s12967-017-1300-y

(15) Elabd C, Centeno CJ, Schultz JR, Lutz G, Ichim T, Silva FJ. Intra-discal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: a long-term safety and feasibility study. J Transl Med. 2016;14(1):253. Published 2016 Sep 1. doi:10.1186/s12967-016-1015-5

(16) Sakai D1, Mochida J, Yamamoto Y, Nomura T, Okuma M, Nishimura K, Nakai T, Ando K, Hotta T. Transplantation of mesenchymal stem cells embedded in Atelocollagen gel to the intervertebral disc: a potential therapeutic model for disc degeneration. Biomaterials. 2003 Sep;24(20):3531-41. DOI: 10.1016/s0142-9612(03)00222-9