Intervertebral Disc Repair by Allogeneic Mesenchymal Bone Marrow Cells: A Randomized Controlled Trial.
Degenerative disc disease often causes severe low-back pain, a public health problem with huge economic and life quality impact. Chronic cases often require surgery, which may lead to biomechanical problems and accelerated degeneration of the adjacent segments. Autologous mesenchymal stromal cells (MSC) treatments have shown feasibility, safety and strong indications of clinical efficacy. We present here a randomized, controlled trial using allogeneic MSC, which are logistically more convenient than autologous cells.



We randomized 24 patients with chronic back pain diagnosed with lumbar disk degeneration and unresponsive to conservative treatments into 2 groups. The test group received allogeneic bone marrow MSCs by intradiscal injection of 25 × 10 cells per segment under local anesthesia. The control group received a sham infiltration of paravertebral musculature with the anesthetic. Clinical outcomes were followed up for 1 year and included evaluation of pain, disability, and quality of life. Disc quality was followed up by magnetic resonance imaging.



Feasibility and safety were confirmed and indications of clinical efficacy were identified. MSC-treated patients displayed a quick and significant improvement in algofunctional indices versus the controls. This improvement seemed restricted to a group of responders that included 40% of the cohort. Degeneration, quantified by Pfirrmann grading, improved in the MSC-treated patients and worsened in the controls.



Allogeneic MSC therapy may be a valid alternative for the treatment of degenerative disc disease that is more logistically convenient than the autologous MSC treatment. The intervention is simple, does not require surgery, provides pain relief, and significantly improves disc quality.
1 Hospital Clínico Universitario de Valladolid, Orthopedic Surgery Department, Spine Unit, Valladolid, Spain. 2 Hospital Clínico Universitario de Valladolid, Radiology Department, Valladolid, Spain. 3 Citospin S.L., Parque Científico de la Universidad de Valladolid, Valladolid, Spain. 4 Hospital Universitario Virgen de la Arrixaca, Department of Hematology and Cell Therapy, Murcia, Spain. 5 Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid and CSIC, Valladolid, Spain.
David C
DC
Noriega
Francisco
F
Ardura
Rubén
R
Hernández-Ramajo
Miguel Ángel
MÁ
Martín-Ferrero
Israel
I
Sánchez-Lite
Borja
B
Toribio
Mercedes
M
Alberca
Verónica
V
García
José M
JM
Moraleda
Ana
A
Sánchez
Javier
J
García-Sancho
D000328:Adult; D001854:Bone Marrow Cells / Q000166:cytology*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000601:surgery*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D059630:Mesenchymal Stem Cells / Q000166:cytology*; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome