title: Intervertebral disc repair by autologous mesenchymal bone marrow cells: a pilot study.
abstract: BACKGROUND
  Degenerative disc disease may cause severe low-back pain, a large public health problem with significant economic and life quality impact. Chronic cases often require surgery, which may lead to biomechanical problems and accelerated degeneration of the adjacent segments. Cell-based therapies may circumvent these problems and have exhibited encouraging results in vitro and in animal studies. We designed a pilot study to assess feasibility and safety and to obtain early indications on efficacy of treatment with mesenchymal stem cells (MSC) in humans.
  
  
  METHODS
  Ten patients with chronic back pain diagnosed with lumbar disc degeneration with intact annulus fibrosus were treated with autologous expanded bone marrow MSC injected into the nucleus pulposus area. Clinical evolution was followed for 1 year and included evaluation of back pain, disability, and quality of life. Magnetic resonance imaging measurements of disc height and fluid content were also performed.
  
  
  RESULTS
  Feasibility and safety were confirmed and strong indications of clinical efficacy identified. Patients exhibited rapid improvement of pain and disability (85% of maximum in 3 months) that approached 71% of optimal efficacy. This outcome compares favorably with the results of other procedures such as spinal fusion or total disc replacement. Although disc height was not recovered, water content was significantly elevated at 12 months.
  
  
  CONCLUSIONS
  MSC therapy may be a valid alternative treatment for chronic back pain caused by degenerative disc disease. Advantages over current gold standards include simpler and more conservative intervention without surgery, preservation of normal biomechanics, and same or better pain relief.
authors.affiliation: Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Orozco
authors.forename: Robert
authors.initials: R
authors.lastname: Soler
authors.forename: Carles
authors.initials: C
authors.lastname: Morera
authors.forename: Mercedes
authors.initials: M
authors.lastname: Alberca
authors.forename: Ana
authors.initials: A
authors.lastname: Sánchez
authors.forename: Javier
authors.initials: J
authors.lastname: García-Sancho
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D010147:Pain Measurement; D010865:Pilot Projects; D011787:Quality of Health Care; D014182:Transplantation, Autologous; D016896:Treatment Outcome