Clinical trials of intervertebral disc regeneration: current status and future developments

Sun, Yi; Leung, Victor; Cheung, Kenneth M.C.

doi:10.1007/s00264-018-4245-8

Cited by 23 publications

(22 citation statements)

References 68 publications

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“…The biological management is promising for the near future. Meanwhile, as Sun et al [32] recommend: large scale, high quality long-term trials should be conducted to clarify the safety and efficacy of these therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Bnon-invasive biological approaches are focused on cell-based therapies, with data primarily from preclinical settings^. On the same topic, Sun et al [32] article is about current status and future developments of intervertebral disc regeneration. BThis review summarizes the current clinical trials that explore the efficacy of covering cell-, growth factor-and small molecule-based approaches.…”

Section: The Future Of Disc Surgery and Disc Regenerationmentioning

confidence: 99%

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Disc herniation and disc disease: the present and the future of management

Benzakour

Benzakour²

2019

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 99%

Section: The Future Of Disc Surgery and Disc Regenerationmentioning

confidence: 99%

Disc herniation and disc disease: the present and the future of management

Benzakour

Benzakour²

2019

International Orthopaedics (SICOT)

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“…Such strategies will have to be dealt with developing a scaffold that leads to regeneration of NP-AF concurrently. With rapidly accumulating knowledge on the advanced drug delivery, cell therapy and stimulatory agents, a more robust approach exploring the diverse biomaterials may provide superior efficacy-targeting NP repair and thus, advanced IVD degeneration therapy may work successfully [117,118]. Importantly, the experimental outcome should intend to correlate with the final aim of chronic back pain relief in humans while considering the clinical translation.…”

Section: Future Research Areas: Attempts To Regenerate the Np Durimentioning

confidence: 99%

Intervertebral Disc Nucleus Repair: Hype or Hope?

Tendulkar

Chen

Ehnert

et al. 2019

IJMS

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Chronic back pain is a common disability, which is often accredited to intervertebral disc degeneration. Gold standard interventions such as spinal fusion, which are mainly designed to mechanically seal the defect, frequently fail to restore the native biomechanics. Moreover, artificial implants have limited success as a repair strategy, as they do not alter the underlying disease and fail to promote tissue integration and subsequent native biomechanics. The reported high rates of spinal fusion and artificial disc implant failure have pushed intervertebral disc degeneration research in recent years towards repair strategies. Intervertebral disc repair utilizing principles of tissue engineering should theoretically be successful, overcoming the inadequacies of artificial implants. For instance, advances in the development of scaffolds aided with cells and growth factors have opened up new possibilities for repair strategies. However, none has reached the stage of clinical trials in humans. In this review, we describe the hitches encountered in the musculoskeletal field and summarize recent advances in designing tissue-engineered constructs for promoting nucleus pulposus repair. Additionally, the review focuses on the effect of biomaterial aided with cells and growth factors on achieving effective functional reparative potency, highlighting the ways to enhance the efficacy of these treatments.

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“…Likewise, bone marrow aspirate Abbreviations: DJD, degenerative joint disease; LBP, lower back pain; IVD, intervertebral disk; BMAC, bone marrow aspirate concentrate; IDD, intervertebral disc degeneration; MRI, magnetic resonance imaging; DDD, degenerative disc disease; ROM, range of motion; MSC(s), mesenchymal stem cell(s); BMA, bone marrow aspirate; VAS, visual analog scale; BPI, back pain index; GLM, general linear model. concentrate (BMAC), which consists of multiple stem cell fractions including MSCs, carries a therapeutic promise in knee DJD (17) and spinal DJD (14,18). In knee DJD, BMAC/MSCs induce significant macroscopic, histopathological, and radiological changes by 6-20 weeks in animal models and improve pain and functionality of patients without severe adverse events (19).…”

Section: Introductionmentioning

confidence: 99%

“…In MRI, these clinical improvements confound with an increase in the water content of treated IVDs in two studies (23). Nevertheless, current clinical evidence remains of low quality due to the paucity of high-level randomized, controlled trials; the unstandardized treatment preparation and dosing; the differences in patients' baseline disease grade; and the variability in follow-up measurements (18,19). Most spinal DJD studies have also sought to target IVD with MSC/BMAC injections, leaving other spinal structures involved in DJD like facet joints, intertransversarii muscles, and interspinous ligaments out of scope (24).…”

Section: Introductionmentioning

confidence: 99%

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

El-Kadiry

Lumbao²,

Rafei

et al. 2021

Front. Med.

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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.

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Clinical trials of intervertebral disc regeneration: current status and future developments

Cited by 23 publications

References 68 publications

Disc herniation and disc disease: the present and the future of management

Disc herniation and disc disease: the present and the future of management

Intervertebral Disc Nucleus Repair: Hype or Hope?

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

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