Intradiscal stem cell implantation for degenerative disk disease

Abstract

Chronic lower back pain (CLBP) is a challenging socioeconomic health matter that leads to progressive debilitation, lost work days, and an extensive impact on the healthcare system. Treatment of CLBP has focused primarily on conservative treatments and interventional pain procedures. If those modalities fail, surgical removal of the pain generating anatomical structure is undertaken, and reconstruction of the spine is performed. These treatments include diskectomy, spinal arthrodesis, total disk replacement, and facet joint replacement. Many of these treatments have variable efficacy and often lead to adjacent spinal segment degeneration. The long-term outcome of these procedures is that a variable percentage of patients obtain enough relief such that they can return to the workforce, and often patients either do not obtain the relief required or have adjacent segment degeneration that results in further surgical reconstruction. The common theme to both nonoperative and operative management is that treatment is focused on a reaction to the disease process. Regenerative medicine however focuses on repair of the damaged spinal structures such that we alter the natural history of the disease process, thereby both reducing symptomatology as well as preventing future spinal degeneration. This chapter presents over 40 years of data that has led us to recent clinical trials examining the use of mesenchymal stem cells to regenerate the intervertebral disk. Current evidence suggests that the mesenchymal stem cell has the ability to both halt the natural history of disk degeneration, alleviate painful symptomatology, and potentially alter the occurrence of adjacent segment disease.