Effect of age on outcomes after allogeneic disc tissue supplementation in patients with chronic discogenic low back pain in the VAST trial

• Published in: Pain management Vol. 12; no. 3; pp. 301 - 311
• Main Authors: Hunter, Corey W, Guyer, Richard, Froimson, Mark, DePalma, Michael J
• Format: Journal Article
• Language: English
• Published: England Future Medicine Ltd 01.04.2022
• Subjects: Adult; Age Factors; allogeneic disc tissue; allograft; Chronic Pain - etiology; Chronic Pain - surgery; degenerative disc disease; discogenic back pain; Female; Humans; Intervertebral Disc - transplantation; Intervertebral Disc Degeneration - complications; Intervertebral Disc Degeneration - surgery; intradiscal therapy; low back pain; Low Back Pain - etiology; Low Back Pain - surgery; Male; Oswestry Disability Index; Pain Measurement; Transplantation, Homologous; Treatment Outcome; Oswestry Disability Index; degenerative disc disease; discogenic back pain; low back pain; allogeneic disc tissue; allograft; intradiscal therapy
• ISSN: 1758-1869; 1758-1877
• DOI: 10.2217/pmt-2021-0078

 To explore the effects of viable allogeneic disc tissue supplementation in younger patients with discogenic chronic low back pain (CLBP). VAST was a randomized placebo-controlled trial of disc allograft supplementation in 218 patients with discogenic CLBP. We conducted a analysis of change from baseline to 12 months in Oswestry Disability Index (ODI) and visual analog scale for pain intensity scores stratified by patient age. Patients aged <42 years receiving allograft experienced greater improvement in ODI (p = 0.042) and a higher ODI response rate (≥10-, ≥15- and ≥20-point reductions in ODI) than those receiving saline (p = 0.001, p = 0.002 and p = 0.021, respectively). Young patients with discogenic CLBP may have significant functional improvement following nonsurgical disc allograft supplementation. The VAST trial evaluated a new treatment for patients with chronic back pain resulting from one or two degenerated spinal discs. The treatment consists of a single injection of disc tissue supplement. A total of 218 adults participated in the study; most received the active treatment, while a smaller number (39 patients) received an injection of saline. In this paper we explain what happened over the 12 months after the injections. Patients who were younger (<42 years old) experienced more functional benefits (i.e., ability to perform daily tasks) after active treatment compared with those who received the saline injection, as measured by disability score. In contrast, older patients (≥42 years old) experienced functional benefits with both active and saline treatments, with no differences between the groups. There were more side effects in both age groups in those who received the active treatment compared with those who received saline, but almost all of the side effects were temporary and not serious. (ClinicalTrials.gov)