A Systematic Review of Mesenchymal Stem Cells in Spinal Cord Injury, Intervertebral Disc Repair and Spinal Fusion

Abstract

Spinal surgery presents a challenge for both neurosurgery and orthopaedic surgery. Due to the heterogeneous differentiation potential of mesenchymal stem cells, there is much interest in the treatment of spine surgery. Animal and human trials focussing on the efficacy of mesenchymal stem cells in spinal cord injury, spine fusion and disc degeneration were included in this systematic review. Published articles up to January 2016 from MEDLINE, PubMed and Ovid were used by searching for specific terms. Of the 2595 articles found, 53 met the selection criteria and were included for analysis (16 on spinal cord injury, 28 on intervertebral disc repair and 9 on spinal fusion). Numerous studies reported better results when the mesenchymal stem cells were used in co-culture with other cells or used in scaffolds. Mesenchymal stem cells were also found to have an immune-modulatory role, which can improve surgical outcome. This systematic review suggests that mesenchymal stem cells can be used safely and effectively for these spinal surgery treatments. Whilst, in certain studies, mesenchymal stem cells did not necessarily show improved results from existing treatments, they provide an alternative option. This can reduce morbidity that arises from current surgical treatment.

Efficacy of administered mesenchymal stem cells in the initiation and co‐ordination of repair processes by resident disc cells in an ovine (Ovis aries) large destabilizing lesion model of experimental disc degeneration

“…Caplan proposed that stem cells should be renamed Medicinal Signaling Cells to more accurately reflect how they home in on injured or diseased tissue sites secreting bioactive factors with immunomodulatory and trophic properties which direct the resident cells to undertake the tissue repair process, this may happen long after the MSCs were present in the defect site . The use of MSCs to undertake IVD repair/regeneration is an area which shows much promise with many publications appearing in the literature dealing with animal model based laboratory studies, preclinical studies, clinical trials (Tables and ) and reviews advocating the use of MSCs for disc repair/regeneration …”

“…Medicinal Signaling Cells to more accurately reflect how they home in on injured or diseased tissue sites secreting bioactive factors with immunomodulatory and trophic properties which direct the resident cells to undertake the tissue repair process, this may happen long after the MSCs were present in the defect site. 27 The use of MSCs to undertake IVD repair/regeneration is an area which shows much promise [28][29][30] with many publications appearing in the literature dealing with animal model based laboratory studies, [31][32][33][34][35][36] preclinical studies, 37,38 clinical trials 39 (Tables 1 and 2) and reviews advocating the use of MSCs for disc repair/regeneration. 28,29,[45][46][47][48][49][50][51] Most pre-clinical studies have treated IVDs with MSCs acutely after induction of disc degeneration, and no direct studies on the relative efficacy of MSCs in different stages of the disease process have been evaluated.…”

Regenerative Medicine for Axial and Radicular Spine‐Related Pain: A Narrative Review

“…In light of this large heterogeneity amongst orthobiologic preparations, injectate delivery method, location, and number of treatments, as well as the paucity of well‐designed randomized controlled trials, the authors opted to present the current literature in the form of a narrative review. A few systematic reviews do exist in the literature on this topic . Having said that, in the absence of improved standardization regarding the aforementioned points, the authors felt a narrative review that included the 3 most common orthobiologic agents used in the treatment of axial/radicular spine pain and the similarities/differences amongst the currently available studies would be most suitable for assistance when interpreting the current literature.…”

Holistic Approach to Axonal Regeneration in Cases of Spinal Cord Injury

“…Neuronal cell death is the primary pathogenetic mechanism in SCI; however, recent advances in stem cell therapy have increased the potential for such therapeutic techniques to benefit the replacement and regeneration of cells, the alleviation of degeneration symptoms, and the recovery of nerve function in the spinal cord [4][5][6][7]. Nonetheless, further development of stem cell therapy techniques has been hampered by logistical and ethical considerations [8][9][10], and the hostile microenvironment at the epicenter of the injury inhibits the survival, integration, and/or endogenous repair of transplanted cells [11,12].…”

“…These challenges have led researchers to adopt a holistic approach to the treatment of SCI -one that focus on altering the injury microenvironment in order to promote the survival and differentiation of transplanted cells [13][14][15]. This review provides a summary of multimodal interventions for the in situ alteration of the microenvironment in the treatment of SCI [7,[16][17][18][19][20].…”