The Analgesic Efficacy of Intradiscal Injection of Bone Marrow Aspirate Concentrate and Culture-Expanded Bone Marrow Mesenchymal Stromal Cells in Discogenic Pain: A Systematic Review

Pain originating from the intervertebral disc (discogenic pain) is a prevalent manifestation of low back pain and is often challenging to treat. Of recent interest, regenerative medicine options with injectable biologics have been trialed in discogenic pain and a wide variety of other painful muscul...

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Bibliographic Details
Published inJournal of Pain Research Vol. 15; pp. 3299 - 3318
Main Authors Her, Yeng F, Kubrova, Eva, Martinez Alvarez, Gabriel A, D'Souza, Ryan S
Format Journal Article Book Review
LanguageEnglish
Published Macclesfield Dove Medical Press Limited 01.01.2022
Taylor & Francis Ltd
Dove
Dove Medical Press
Subjects
Back pain
Back surgery
Backache
Bias
bmac
Body fat
Bone marrow
bone marrow mesenchymal stromal cells
Care and treatment
discogenic pain
Observational studies
Pain
Review
Stem cells
Systematic review
Vertebrae
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Summary:Pain originating from the intervertebral disc (discogenic pain) is a prevalent manifestation of low back pain and is often challenging to treat. Of recent interest, regenerative medicine options with injectable biologics have been trialed in discogenic pain and a wide variety of other painful musculoskeletal conditions. In particular, the role of bone marrow aspirate concentrate (BMAC) and culture-expanded bone marrow derived mesenchymal stromal cells (BM-MSCs) in treating discogenic pain remains unclear. The primary objective of this systematic review was to appraise the evidence of intradiscal injection with BMAC and culture-expanded BM-MSCs in alleviating pain intensity from discogenic pain. Secondary outcomes included changes in physical function after intradiscal injection, correlation between stromal cell count and pain intensity, and anatomical changes of the disc assessed by radiographic imaging after intradiscal injection. Overall, 16 studies consisting of 607 participants were included in qualitative synthesis without pooling. Our synthesis revealed that generally intradiscal autologous or allogeneic BMAC and culture-expanded BM-MSCs improved discogenic pain compared to baseline. Intradiscal injection was also associated with improvements in physical functioning and positive anatomical changes on spine magnetic resonance imaging (improved disc height, disc water content, Pfirrmann grading) although anatomical findings were inconsistent across studies. However, the overall GRADEscore for this study was very low due to heterogeneity and poor generalizability. There were no serious adverse events reported post intradiscal injection except for a case of discitis. Keywords: BMAC, discogenic pain, bone marrow mesenchymal stromal cells
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ISSN:1178-7090
1178-7090
DOI:10.2147/JPR.S373345