Disc regeneration therapy using marrow mesenchymal cell transplantation: a report of two case studies.
METHODS
Marrow mesenchymal cells (MSCs) contain stem cells and possess the ability to regenerate bone, cartilage, and fibrous tissues. Here, we applied this regenerative ability to intervertebral disc regeneration therapy in an attempt to develop a new spinal surgery technique.


OBJECTIVE
We analyzed the regenerative restoration ability of autologous MSCs in the markedly degenerated intervertebral discs.


BACKGROUND
Fusion for lumbar intervertebral disc instability improves lumbago. However, fused intervertebral discs lack the natural and physiologic functions of intervertebral discs. If intervertebral discs can be regenerated and repaired, then damage to adjacent intervertebral discs can be avoided. We verified the regenerative ability of MSCs by animal studies, and for the first time, performed therapeutic intervertebral disc regeneration therapy in patients and obtained favorable findings.


METHODS
Subjects were 2 women aged 70 and 67 years; both patients had lumbago, leg pain, and numbness. Myelography and magnetic resonance imaging showed lumbar spinal canal stenosis, and radiograph confirmed the vacuum phenomenon with instability. From the ilium of each patient, marrow fluid was collected, and MSCs were cultured using the medium containing autogenous serum. In surgery, fenestration was performed on the stenosed spinal canal and then pieces of collagen sponge containing autologous MSCs were grafted percutaneously to degenerated intervertebral discs.


RESULTS
At 2 years after surgery, radiograph and computed tomography showed improvements in the vacuum phenomenon in both patients. On T2-weighted magnetic resonance imaging, signal intensity of intervertebral discs with cell grafts was high, thus indicating high moisture contents. Roentgenkymography showed that lumbar disc instability improved. Symptom was alleviated in both patients.


CONCLUSIONS
The intervertebral disc regeneration therapy using MSC brought about favorable results in these 2 cases. It seems to be a promising minimally invasive treatment.
Yoshikawa
Takafumi
T
Department of Orthopedic Surgery, Koriyama-Seiran Hospital, 1-1 Honjo, Yamato-koriyama, Nara, Japan. t-yoshikawa@seiran.or.jp
Ueda
Yurito
Y
Miyazaki
Kiyoshi
K
Koizumi
Munehisa
M
Takakura
Yoshinori
Y
D000368:Aged; D002478:Cells, Cultured; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000502:physiology* / Q000601:surgery; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D045164:Mesenchymal Stem Cell Transplantation; D011859:Radiography; D012038:Regeneration / Q000502:physiology*; D014182:Transplantation, Autologous