Autologous BMAC Therapy Improves Spinal Degenerative Joint Disease in Lower Back Pain Patients

Abstract

Spinal degenerative joint disease (DJD) is associated with lower back pain (LBP) arising from the degeneration of intervertebral discs (IVD), facet joints, intertransversarii muscles, and interspinous ligaments among other anatomical structures. To circumvent the socioeconomic burdens and often-problematic surgical options imposed by DJD therapy, cell-based biologic modalities like bone marrow aspirate concentrate (BMAC) have been investigated in pre-clinical and clinical settings, mostly for IVD degeneration (IDD), with encouraging outcomes. In this study, we evaluated the differences in therapeutic benefits of BMAC between IVD- and facet joint-originating chronic LBP. Eighteen patients diagnosed with chronic LBP met the selection criteria. Following discography and provocation testing, 13 patients tested positive and were assigned into IDD-associated LBP (1st arm), while the remaining 5 tested negative and were assigned into facetogenic LBP (2nd arm). Autologous BMAC was injected intradiscally in the 1st arm, while the 2nd arm received posterior spinal chain injections. No procedure-related serious events ensued. Clinical improvement was evaluated over 12 months based on pain and functionality questionnaires (VAS, BPI, RAND-36), opioid use, and changes in disc parameters assessed by magnetic resonance imaging (MRI). Ameliorated VAS and BPI scores differed significantly between both arms in favor of IDD patients who also took significantly less opioids. Average RAND-36 scores showed no significant difference between groups albeit a trend suggesting improvement was observed in IDD patients. MRI scans conducted on IDD patients demonstrated marked elevation in disc height and spinal canal space size without worsening disc quality. Overall, this is the first study investigating the potency of BMAC as an IDD treatment in Canada and the first globally for addressing facetogenic pain using cellular therapy.

Efficacy of DiscoGel in Treatment of Degenerative Disc Disease: A Prospective 1-Year Observation of 67 Patients

“…Various minimally invasive treatments have been proposed for chronic DP, such as intradiscal injections (dextrose solution, [ 39 ], platelet-rich plasma [ 40 ], bone marrow concentrate [ 41 ], lipoaspirate [ 42 ], ozone [ 43 ]), intradiscal electrothermal annuloplasty [ 44 ], automated percutaneous mechanical discectomy [ 45 ], and basivertebral/sinuvertebral nerve thermocoagulation [ 46 ].…”

Cell Therapy: Types, Regulation, and Clinical Benefits

“…The processing of BMA to concentrate nucleated cell yields, such as MSCs which represent 0.001% of the non-hematopoietic, multipotent cellular portion of BMA, yields BMAC ( 198 ). The concentration of BMA can be performed by different techniques, including automated centrifugation systems ( 208 ) or cell filtration systems ( 209 ). In BMAC, concentrations of nucleated cells become 5-fold higher, and concentrations of MSCs 6-fold higher ( 210 , 211 ).…”

“…Generally, the clinical application of BMAC spans orthopedic settings, in which it can be sterilely injected intra-articularly under the guidance of fluoroscopy or ultrasonography ( 215 ). Like SVF, BMAC functions in various mechanisms involving paracrine signaling by MSCs and nucleated cells that drive tissue repair and immunomodulation ( 66 , 209 , 210 ) and by growth factors and cytokines that induce tissue growth and promote reparative processes ( 198 , 216 ).…”

“…BMAC has emerged as a potential alternative for regenerative therapy, owing mainly to its enriched composition of growth factors and MSCs among other cell types ( 216 ). In regenerative settings—mainly orthopedics—BMAC has demonstrated a promising potential, as it provided patients with clinical benefits and/or improved diagnostic imaging outcomes of patients ( 209 , 274 , 275 ). To date, there are at least 14 active or recruiting registered studies involving BMAC as an intervention mainly in orthopedic conditions ( 276 ).…”

“…The mechanism of action of BMAC remains unclear, and no serious attempts have been made to delineate the interactions between the different components of BMAC, which might collectively be at the origins of BMAC outcomes ( 277 , 278 ). Among the components theorized to contribute to the therapeutic potential of BMAC are MSCs, which are endowed with tissue function-enhancing regenerative and immunologic properties ( 66 , 209 , 210 ); growth factors, which promote tissue growth; and nucleated cells (e.g., lymphocytes), which secrete various reparative cytokines and growth factors that act via paracrine pathways ( 198 , 216 ). However, the conclusions drawn by these reports about the role of BMAC components—specifically MSCs—in driving clinical outcomes are based on rather extrapolations than benchwork.…”