Lumbar Discitis and Osteomyelitis After a Spinal Stem Cell Injection?

Abstract

Case: A 32-year-old man developed lumbar discitis and osteomyelitis after receiving a cell-based injection for the treatment of degenerative disc disease. Initial cultures were negative, but he continued to worsen, and a repeat set of cultures was taken. On day 10, Cutibacterium acnes was isolated. He was then successfully treated with 12 weeks of intravenous antibiotics. Conclusions: There is minimal regulation on the preparation or administration of cell-based interventions. It is important to consider slow growing organisms such as C. acnes in patients presenting with spinal infection with insidious onset after these treatments.

Comprehensive narrative review on the analysis of outcomes from cell transplantation clinical trials for discogenic low back pain

“…For this narrative review, we examine multiple reports and studies including case reports, case series, pilot studies, and clinical trials [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] ( Table 1 ). Note that in our review, reports discussing the same clinical trial (e.g., reports with multiple follow-up periods) are reported as a single study, referred to by the first-author of the most recent publication.…”

“… Wolff [70] 1 ✔ 39% of pts reported ≥50% NRS improvement n.a. Ramos [71] 1 n.a. - - El-Kadiry [72] 1 ✔ Significant 3.8cm VAS improvement (=63%) 17.2 BPI improvement (=35%) n.a.…”

“… Wolff [70] 1 ✔ 31% of pts reported ≥50% ODI improvement n.a. Ramos [71] 1 n.a. - - El-Kadiry [72] 1 ?…”

“… - n.a. Ramos [71] 1 n.a. - - El-Kadiry [72] 1 ✔ Significant 0.8 mm increase in DHI (=11%) 4 discs improved in Pfirrmann grading 1 disc worsened in Pfirrmann grading n.a.…”

“… Mixture of cells Pettine [67] , [68] , [69] 26 ✘ ✓ Pain (n=?) Wolff [70] 33 ✘ ✘ - Ramos [71] 1 ✓ ✓ Lumbar discitis (n=1) Osteomyelitis (n=1) El-Kadiry [72] 13 ✘ ✘ - Jerome [73] 3 ✓ ✓ Pain (n=3) Constipation (n=2) Fever (n=2) Elevated CRP (n=2) Discitis (n=1) Spondylodiscitis (n=2) Epidural abscess (n=1) Xu [74] 15 ✘ ✘ - Subach [75] 1 ✓ ✓ Disc extrusion (n=1) Osteomyelitis (n=1) Discitis (n=1) Epidural abscess (n=1) Cauda equina (n=1) Haufe [76] 10 ? ?…”